Rodriguez G, Nobili F, Celestino M A, Francione S, Gulli G, Hassan K, Marenco S, Rosadini G, Cordera R
Department of Motor Science-Neurophysiopathology, University of Genova, Italy.
Diabetes Care. 1993 Feb;16(2):462-8. doi: 10.2337/diacare.16.2.462.
To investigate both rCBF and cerebrovascular reactivity, evaluated as pre- and post-ACZ rCBF differences in a group of IDDM patients with differences in duration of disease and severity of complications.
rCBF was measured by the 133Xenon inhalation method in 20 IDDM patients and in 15 healthy control subjects before and after an intravenous injection of ACZ, a carbonic anhydrase inhibitor commonly used to assess cerebrovascular reactivity.
Basal global CBF (the mean of 32 regional values) was within the normal range in all patients but 1, who showed slight hyperperfusion; moreover, in 3 patients with long-lasting disease, some hypoperfused regions were found. ANOVA showed an inverse correlation between basal global CBF (P < 0.01) and duration of diabetes, but no correlation with Hb, MABP, serum glucose concentration, or GHb. Compared with control subjects, the percentage of global CBF increment after ACZ administration was significantly impaired in 4 patients and gave a borderline response in 2 patients; 4 of these poor ACZ responders had retinopathy, and 1 had suffered from a TIA. Duration of diabetes, Hb, MABP, serum glucose concentration, and GHb did not correlate with the percentage of post-ACZ global CBF changes, and did not differ among the 6 poor ACZ responders and the other diabetic patients or control subjects.
These results confirm that global CBF is within the normal range in most IDDM patients, although it is significantly influenced by the duration of diabetes; pathophysiological correlates of the altered cerebrovascular reactivity need to be further investigated. rCBF measurements, before and after ACZ administration, seem to represent a safe and reliable tool for assessing cerebrovascular function in IDDM.
在一组糖尿病病程和并发症严重程度存在差异的胰岛素依赖型糖尿病（IDDM）患者中，研究局部脑血流量（rCBF）以及以乙酰唑胺（ACZ）给药前后rCBF差异评估的脑血管反应性。
通过吸入133氙的方法，在20例IDDM患者和15名健康对照者静脉注射ACZ（一种常用于评估脑血管反应性的碳酸酐酶抑制剂）前后测量rCBF。
除1例表现为轻度血流灌注过多的患者外，所有患者的基础全脑CBF（32个区域值的平均值）均在正常范围内；此外，在3例病程较长的患者中发现了一些血流灌注不足的区域。方差分析显示基础全脑CBF与糖尿病病程呈负相关（P < 0.01），但与血红蛋白（Hb）、平均动脉压（MABP）、血糖浓度或糖化血红蛋白（GHb）无关。与对照者相比，4例患者在给予ACZ后全脑CBF增加的百分比显著受损，2例患者呈临界反应；这些ACZ反应不佳的患者中有4例患有视网膜病变，1例曾患短暂性脑缺血发作（TIA）。糖尿病病程、Hb、MABP、血糖浓度和GHb与ACZ给药后全脑CBF变化的百分比无关，在6例ACZ反应不佳的患者与其他糖尿病患者或对照者之间也无差异。
这些结果证实，尽管大多数IDDM患者的全脑CBF受糖尿病病程的显著影响，但仍在正常范围内；脑血管反应性改变的病理生理相关性需要进一步研究。ACZ给药前后的rCBF测量似乎是评估IDDM患者脑血管功能的一种安全可靠的工具。
