Smits P, Hersbach F M, Jansen T L, Thien T, Lutterman J A
Department of Medicine, University Hospital of Nijmegen, The Netherlands.
Diabetes. 1993 Oct;42(10):1454-61. doi: 10.2337/diab.42.10.1454.
Diabetes mellitus has been associated with both elevated plasma concentrations of the natriuretic and vasorelaxant hormone atrial natriuretic factor and with a reduced natriuretic response to this hormone. We now hypothesize that the vasodilator response to atrial natriuretic factor is attenuated in IDDM. Forearm vasodilator responses to the infusion of six increasing dosages of atrial natriuretic factor into the brachial artery were registered by venous occlusion strain gauge plethysmography in 10 patients with uncomplicated IDDM and in 10 age-, sex-, and weight-matched control subjects. Baseline levels of blood pressure, forearm blood flow, and plasma concentrations of atrial natriuretic factor were not different between control subjects and patients with diabetes. In control subjects, atrial natriuretic factor induced a percentage fall in the forearm vascular resistance of -29 +/- 5% at the lowest to -72 +/- 4% at the highest infusion rate. In patients with diabetes this fall was significantly attenuated, measuring -2 +/- 7 and -45 +/- 4%, respectively, (P < 0.001 vs. control subjects). During infusion of atrial natriuretic factor into the brachial artery, the calculated regional production of cGMP (second messenger of atrial natriuretic factor) increased from 1.2 +/- 1.1 to 22.8 +/- 4.8 pmol.min-1 x 100 ml-1 in the control subjects, whereas hardly any change occurred in the patients with diabetes (from -2.1 +/- 1.2 to 2.9 +/- 4.7 pmol.min-1 x 100 ml-1). Furthermore, both control and diabetic subjects demonstrated an equal forearm vasodilator response to increasing infusion rates of the control vasodilator sodium nitroprusside. We conclude that uncomplicated IDDM is associated with a specific reduction in the vascular responsiveness to atrial natriuretic factor.(ABSTRACT TRUNCATED AT 250 WORDS)
糖尿病与利钠和血管舒张激素心房利钠因子的血浆浓度升高以及对该激素的利钠反应降低均有关联。我们现在推测，胰岛素依赖型糖尿病（IDDM）患者对心房利钠因子的血管舒张反应减弱。通过静脉阻断应变计体积描记法，记录了10例无并发症的IDDM患者和10例年龄、性别及体重匹配的对照者在向肱动脉输注六种递增剂量心房利钠因子时的前臂血管舒张反应。对照组和糖尿病患者的血压、前臂血流量及心房利钠因子血浆浓度的基线水平并无差异。在对照组中，心房利钠因子在最低输注速率时使前臂血管阻力下降百分比为-29±5%，在最高输注速率时为-72±4%。在糖尿病患者中，这种下降显著减弱，分别为-2±7%和-45±4%（与对照组相比，P<0.001）。在向肱动脉输注心房利钠因子期间，对照组中计算得出的环磷酸鸟苷（心房利钠因子的第二信使）局部生成量从1.2±1.1增加至22.8±4.8 pmol·min-1×100 ml-1，而糖尿病患者几乎没有变化（从-2.1±1.2至2.9±4.7 pmol·min-1×100 ml-1）。此外，对照组和糖尿病组对对照血管舒张剂硝普钠输注速率增加的前臂血管舒张反应相同。我们得出结论，无并发症的IDDM与对心房利钠因子的血管反应性特异性降低有关。（摘要截短至250字）
