Lambert J, Aarsen M, Donker A J, Stehouwer C D
Department of Internal Medicine, Academic Hospital, Vrije Universiteit, Amsterdam, the Netherlands.
Arterioscler Thromb Vasc Biol. 1996 May;16(5):705-11. doi: 10.1161/01.atv.16.5.705.
Vascular complications in diabetes mellitus are associated with endothelial dysfunction. Whether endothelium-dependent vasodilation is impaired in normoalbuminuric patients with insulin-dependent diabetes mellitus (IDDM) is controversial. Using a noninvasive echo-Doppler method, we investigated endothelium-dependent and endothelium-independent vasodilation in the brachial artery of IDDM patients. There were 52 normoalbuminuric and normotensive patients with IDDM (aged 31.9 +/- 9.8 years; diabetes duration, 14.9 +/- 7.9 years; glycated hemoglobin, 7.9 +/- 1.2%) and 52 healthy control group (C) subjects comparable for age and sex studied. Brachial artery diameter was measured at baseline, during postocclusion reactive hyperemia (flow-mediated, endothelium-dependent dilation [FMD]), and after 400 micrograms glyceryl trinitrate (GTN) sublingually (endothelium-independent vasodilation). Vasodilation was expressed as the percentage change relative to the baseline diameter. Baseline flow and blood pressure were similar for IDDM patients and C. Baseline vessel diameter was slightly larger in IDDM patients (3.10 +/- 0.52 mm) compared with C (2.89 +/- 0.55 mm, P = 5.0). FMD in IDDM patients was decreased (12.0 +/- 9.1% versus 15.7 +/- 9.5% in C, P = .046), as was GTN-induced vasodilation (14.9 +/- 8.2% versus 18.3 +/- 8.5% in C, P = .045). After correction for the difference in baseline diameter, FMD and GTN-induced dilation were not different between the groups. GTN-induced vasodilation decreased slightly with increasing diabetes duration. There was no relation between the vasodilatory responses and HbA1c. In normoalbuminuric IDDM patients, endothelium-dependent as well as endothelium-independent vasodilation are normal when the difference in baseline diameter is taken into account.
糖尿病中的血管并发症与内皮功能障碍有关。胰岛素依赖型糖尿病（IDDM）的正常白蛋白尿患者的内皮依赖性血管舒张是否受损存在争议。我们使用无创回声多普勒方法，研究了IDDM患者肱动脉的内皮依赖性和非内皮依赖性血管舒张。有52例正常白蛋白尿且血压正常的IDDM患者（年龄31.9±9.8岁；糖尿病病程14.9±7.9年；糖化血红蛋白7.9±1.2%）和52例年龄和性别相匹配的健康对照组（C）受试者参与研究。在基线、闭塞后反应性充血期间（血流介导的内皮依赖性舒张[FMD]）以及舌下含服400微克硝酸甘油（GTN）后（非内皮依赖性血管舒张）测量肱动脉直径。血管舒张以相对于基线直径的百分比变化表示。IDDM患者和C组的基线血流和血压相似。与C组（2.89±0.55毫米，P=5.0）相比，IDDM患者的基线血管直径略大（3.10±0.52毫米）。IDDM患者的FMD降低（12.0±9.1%，而C组为15.7±9.5%，P=0.046），GTN诱导的血管舒张也降低（14.9±8.2%，而C组为18.3±8.5%，P=0.045）。在校正基线直径差异后，两组之间的FMD和GTN诱导的舒张无差异。GTN诱导的血管舒张随糖尿病病程延长略有降低。血管舒张反应与糖化血红蛋白之间无相关性。在正常白蛋白尿的IDDM患者中，考虑到基线直径差异时，内皮依赖性和非内皮依赖性血管舒张均正常。
