Clarkson P, Celermajer D S, Donald A E, Sampson M, Sorensen K E, Adams M, Yue D K, Betteridge D J, Deanfield J E
Cardiothoracic Unit, Great Ormond Street Hospital for Children National Health Service Trust, London, England, United Kingdom.
J Am Coll Cardiol. 1996 Sep;28(3):573-9. doi: 10.1016/0735-1097(96)82380-1.
This study sought to examine whether endothelial function is impaired in the large vessels of asymptomatic young adults with insulin-dependent diabetes and whether endothelial dysfunction is related to duration or control of diabetes, small-vessel disease or other vascular risk factors.
Endothelial dysfunction is an early event in atherosclerosis, and large-vessel atherosclerotic disease is the major cause of morbidity and mortality in diabetes.
We compared 80 young adults with insulin-dependent diabetes (15 to 40 years old; mean [+/- SD] diabetes duration 13 +/- 8 years) with 80 matched nondiabetic control subjects. Using high resolution vascular ultrasound, we measured brachial artery responses to reactive hyperemia (with increased flow causing endothelium-dependent dilation) and sublingual glyceryltrinitrate (causing endothelium-independent dilation).
Flow-mediated dilation was significantly impaired in diabetic subjects (5.0 +/- 3.7% vs. 9.3 +/- 3.8% in control subjects, p < 0.001). The ratio of flow-mediated dilation to glyceryltrinitrate-induced dilation was significantly lower in the diabetic subjects (p < 0.02), indicating that impaired dilation to increased flow was out of proportion to the impairment of the glyceryltrinitrate response in these subjects (15.6 +/- 5.6% vs. 19.7 +/- 6.6% in control subjects, p < 0.001). On multivariate analysis, flow-mediated dilation was inversely related to both duration of diabetes (r = -0.26, p < 0.05) and low density lipoprotein (LDL) cholesterol levels (r = -0.38, p < 0.005).
Vascular reactivity is impaired in the systemic arteries of asymptomatic young adults with insulin-dependent diabetes and may represent early large-vessel disease. The degree of impairment is related to the duration of diabetes, and these patients appear particularly vulnerable to damage from LDL cholesterol, even at levels considered acceptable in nondiabetic subjects.
本研究旨在探讨胰岛素依赖型糖尿病无症状年轻成人的大血管内皮功能是否受损，以及内皮功能障碍是否与糖尿病病程、控制情况、小血管疾病或其他血管危险因素相关。
内皮功能障碍是动脉粥样硬化的早期事件，大血管动脉粥样硬化疾病是糖尿病发病和死亡的主要原因。
我们将80名胰岛素依赖型糖尿病年轻成人（15至40岁；平均[±标准差]糖尿病病程13±8年）与80名匹配的非糖尿病对照者进行比较。使用高分辨率血管超声，我们测量了肱动脉对反应性充血（血流增加导致内皮依赖性扩张）和舌下硝酸甘油（导致非内皮依赖性扩张）的反应。
糖尿病患者的血流介导的扩张明显受损（5.0±3.7%，而对照者为9.3±3.8%，p<0.001）。糖尿病患者中血流介导的扩张与硝酸甘油诱导的扩张的比值明显较低（p<0.02），表明这些患者中对血流增加的扩张受损与硝酸甘油反应受损不成比例（15.6±5.6%，而对照者为19.7±6.6%，p<0.001）。多变量分析显示，血流介导的扩张与糖尿病病程（r=-0.26，p<0.05）和低密度脂蛋白（LDL）胆固醇水平（r=-0.38，p<0.005）均呈负相关。
胰岛素依赖型糖尿病无症状年轻成人的全身动脉血管反应性受损，可能代表早期大血管疾病。受损程度与糖尿病病程相关，这些患者似乎特别容易受到LDL胆固醇的损害，即使在非糖尿病患者认为可接受的水平也是如此。
