胰岛素依赖型糖尿病患者冠状动脉血流储备降低的证据。人类糖尿病性心脏病的一个可能病因。

Evidence for reduced coronary flow reserve in patients with insulin-dependent diabetes. A possible cause for diabetic heart disease in man.

作者信息

Strauer B E, Motz W, Vogt M, Schwartzkopff B

机构信息

Department of Medicine, University of Düsscldorf, Germany.

出版信息

Exp Clin Endocrinol Diabetes. 1997;105(1):15-20. doi: 10.1055/s-0029-1211722.

DOI:10.1055/s-0029-1211722

PMID:9088890

Abstract

UNLABELLED

In diabetic heart disease myocardial, interstitial, coronary and neural structures are often involved. Coronary microangiopathy is supposed to contribute an essential part, which has not yet been clearly analysed.

METHODS

In 9 normotensive patients with insulin-treated diabetes (DP) with clinically suspected coronary heart disease but normal epicardial coronary arteries, coronary microcirculation was studied. Coronary flow was determined as the quotient of base line and minimal coronary resistance after dipyridamole (0.5 mg/kg i.v.), using the argon-gas-chromatography method. Systolic left ventricular function was analysed by ventriculography, diastolic function by M-Mode-echocardiography and Doppler-echocardiograhy. Twelve normotensive subjects served as control group (CON).

RESULTS

In diabetic patients maximal coronary flow was significantly reduced (172 +/- 5 versus 395 +/- 103 ml/min x 100 g, p < or = 0.001) and minimal coronary resistance increased (0.6 +/- 0.19 versus 0.24 +/- 0.06 mmHg x min x 100 g/ml, p < 0.001). Coronary reserve in diabetics was markedly reduced (1.84 +/- 0.39 versus 4.23 +/- 0.52, p < or = 0.001). Global systolic function was normal in all patients (EF: DP: 72 +/- 13 versus CON: 77 +/- 12%, n.s.; cardiac index: DP: 3.2 +/- 0.8 versus CON: 3.3 +/- 1.2 1/ min x m2, n.s.). Diastolic function was impaired in diabetics with an increased relaxation time index (97 +/- 23 versus 45 +/- 18 msec, p < or = 0.01) and an impaired diastolic inflow pattern, indicated by the E/A-ratio (0.75 +/- 0.14 versus 1.66 +/- 0.13, p < or = 0.05).

CONCLUSIONS

The reduced coronary flow reserve in patients with insulin-treated diabetes mellitus may play a crucial role in the pathophysiology of diabetic cardiopathy, causing myocardial ischaemia due to a disturbance of coronary microcirculation leading to diastolic dysfunction and progressing assumably to systolic failure.

摘要

未标注

在糖尿病性心脏病中，心肌、间质、冠状动脉和神经结构常受累。冠状动脉微血管病变被认为是一个重要因素，但尚未得到明确分析。

方法

对9例接受胰岛素治疗的糖尿病患者（DP）进行研究，这些患者临床上怀疑患有冠心病，但心外膜冠状动脉正常。采用氩气色谱法，以双嘧达莫（0.5mg/kg静脉注射）后基线与最小冠状动脉阻力的商来测定冠状动脉血流。通过心室造影分析左心室收缩功能，通过M型超声心动图和多普勒超声心动图分析舒张功能。12名血压正常的受试者作为对照组（CON）。

结果

糖尿病患者的最大冠状动脉血流显著降低（172±5 vs 395±103ml/min×100g，p≤0.001），最小冠状动脉阻力增加（0.6±0.19 vs 0.24±0.06mmHg×min×100g/ml，p＜0.001）。糖尿病患者的冠状动脉储备明显降低（1.84±0.39 vs 4.23±0.52，p≤0.001）。所有患者的整体收缩功能正常（射血分数：DP组72±13 vs CON组77±12%，无显著性差异；心脏指数：DP组3.2±0.8 vs CON组3.3±1.2 1/min×m2，无显著性差异）。糖尿病患者的舒张功能受损，舒张时间指数增加（97±23 vs 45±18msec，p≤0.01），舒张期血流模式受损，表现为E/A比值（0.75±0.14 vs 1.66±0.13，p≤0.05）。