Takir Mumtaz, Telci Caklili Ozge, Betul Ozcan Fatma, Atici Adem, Caliskan Mustafa
Department of Endocrinology and Metabolism, Suleyman Yalcin City Hospital, Istanbul, Türkiye.
Department of Endocrinology and Metabolism, Kocaeli City Hospital, Kocaeli, Türkiye.
Biomol Biomed. 2025 Apr 26;25(6):1345-1350. doi: 10.17305/bb.2024.10940.
Glomerular hyperfiltration (GHF) is an early marker of chronic kidney disease (CKD) and may predict coronary microvascular dysfunction, presenting as reduced coronary flow velocity reserve (CFVR) in patients with a history of gestational diabetes (GDM). This study aimed to assess the glomerular filtration rate (GFR) and compare CFVR in patients with a history of GDM. We screened patients referred to the Cardiology Department of Istanbul Medeniyet University for angina pectoris, excluding those with positive treadmill test results. Women with a history of GDM were categorized into three groups based on GFR levels: Group 1 (60-89 ml/min), Group 2 (90-119 ml/min), and Group 3 (≥ 120 ml/min). Coronary diastolic peak velocities were measured at baseline and after dipyridamole administration, with CFVR defined as the ratio of hyperemic to baseline diastolic peak velocities. The homeostasis model assessment of insulin resistance (HOMA-IR) and body mass index were derived from patient files. A total of 166 patients were included: 57 in Group 1, 80 in Group 2, and 29 in Group 3. HOMA-IR was higher in Group 3 compared to Group 2 (P < 0.05). Group 1 had the lowest CFVR (2.3 ± 0.3%), Group 2 had the highest (2.5 ± 0.3%), and Group 3 showed a moderate decrease in CFVR (2.4 ± 0.3%). Multivariate linear regression analysis revealed that HbA1c was independently associated with CFVR. In patients with GDM, GHF is associated with reduced CFVR, linked to metabolic parameters such as HbA1c and HOMA-IR. Interventions to improve metabolic health may prevent cardiovascular disease in these patients.
肾小球高滤过（GHF）是慢性肾脏病（CKD）的早期标志物，可能预示冠状动脉微血管功能障碍，表现为有妊娠期糖尿病（GDM）病史的患者冠状动脉血流速度储备（CFVR）降低。本研究旨在评估有GDM病史患者的肾小球滤过率（GFR）并比较其CFVR。我们对转诊至伊斯坦布尔梅迪尼耶特大学心脏病科的心绞痛患者进行筛查，排除平板运动试验结果阳性的患者。有GDM病史的女性根据GFR水平分为三组：第1组（60 - 89 ml/min）、第2组（90 - 119 ml/min）和第3组（≥120 ml/min）。在基线和给予双嘧达莫后测量冠状动脉舒张期峰值速度，CFVR定义为充血期与基线舒张期峰值速度之比。胰岛素抵抗的稳态模型评估（HOMA - IR）和体重指数来自患者病历。共纳入166例患者：第1组57例，第2组80例，第3组29例。第3组的HOMA - IR高于第2组（P < 0.05）。第1组的CFVR最低（2.3±0.3%），第2组最高（2.5±0.3%），第3组的CFVR中度降低（2.4±0.3%）。多变量线性回归分析显示糖化血红蛋白（HbA1c）与CFVR独立相关。在有GDM的患者中，GHF与CFVR降低相关，与HbA1c和HOMA - IR等代谢参数有关。改善代谢健康的干预措施可能预防这些患者的心血管疾病。
