Impairments in microvascular function and skeletal muscle oxygenation in women with gestational diabetes mellitus: links to cardiovascular disease risk factors
Impairments in microvascular function and skeletal muscle oxygenation in women with gestational diabetes mellitus: links to cardiovascular disease risk factors
复制标题
DOI：
10.1007/s00125-016-4129-7
复制
发表时间：
2017-01-01
期刊：
影响因子：
8.2
通讯作者：
Goulis, Dimitrios G.
中科院分区：
文献类型：
--
作者：
Dipla, Konstantina;Triantafyllou, Areti;Goulis, Dimitrios G.
妊娠期糖尿病(GDM)是血管内皮功能障碍和心血管疾病的危险因素。然而，GDM在体内的微血管内皮细胞功能尚未被研究。本研究旨在利用近红外光谱(NIRS)检测：(1)妊娠期糖尿病(GDM)和正常妊娠(NDM)患者静息和运动时的微血管反应性和骨骼肌耗氧量(M)是否存在差异；(2)NIRS指标与大血管功能和心血管疾病危险因素之间是否存在相关性。29例孕妇(13例妊娠期糖尿病和16例正常妊娠，孕28+/-2周)接受了动脉僵硬(脉搏波速度[PWV])和24小时动态血压(24小时BP)评估。在动脉阻断/再灌流和间歇性握力训练过程中，近红外连续监测肌肉氧合和脱氧血红蛋白以及组织氧饱和度指数(TSI，%)的变化。在血管闭塞和再灌注期间，GDM患者的TSI反应较慢(闭塞斜率：GDM和对照组分别为-0.06+/-0.02和-0.10+/-0.04；再灌注斜率：0.65+/-0.26vs1.05+/-0.41)，m降低(1.3+/-1.2mU/-1.2vs3.8+/-2.3mU·m-1)，闭合性充血(Delta TSI6.8+/-2.9vs9.5+/-3.4)与对照组比较(P<0.01)。尽管妊娠期糖尿病组和对照组的握力相似(分别为29.1+/-8.1千克和26.2+/-10.4千克)，但在前臂反复收缩的过程中，妊娠期糖尿病患者的TSI反应迟钝(6.5+/-3.9比19.2+/-10.9；p<；0.01)，维持预定握力的能力降低(23.4+/-2.9比27.4+/-3.8%，p<；0.05)。NIRS指数与妊娠早期PWV、24 h BP和血糖浓度呈正相关(r=0.40~0.60；p<；0.05)。GDM患者的TSI曲线呈典型的钝化特征，与未合并妊娠的患者相比，GDM患者的肌肉氧合和微血管反应性发生了改变。这些变化在运动中表现出来，可能是导致妊娠期糖尿病患者运动耐量降低的原因之一。NIRS指数与大血管指数(动脉僵硬)和24小时血压相关。
Gestational diabetes mellitus (GDM) is a risk factor for the development of endothelial dysfunction and cardiovascular disease. However, in vivo microvascular endothelial function in GDM has not been investigated. This study aimed to examine, using near-infrared spectroscopy (NIRS), whether: (1) there are differences in microvascular reactivity and skeletal muscle oxygen consumption (m) at rest and during exercise between GDM and uncomplicated pregnancies; and (2) there is an association of NIRS indices with macrovascular function and cardiovascular disease risk factors.Twenty-nine pregnant women (13 with GDM and 16 women with uncomplicated pregnancy, 28 +/- 2 gestational weeks) underwent arterial stiffness (pulse wave velocity [PWV]) and 24 h ambulatory BP (24 h BP) evaluation. NIRS continuously monitored, non-invasively, changes in muscle oxygenated and deoxygenated haemoglobin and tissue O-2 saturation index (TSI, %) during arterial occlusion/reperfusion and intermittent handgrip exercise. m and vascular reactivity indices were calculated.During occlusion and reperfusion, women with GDM exhibited slower TSI response (occlusion slope: -0.06 +/- 0.02 vs -0.10 +/- 0.04, in GDM and controls, respectively; reperfusion slope: 0.65 +/- 0.26 vs 1.05 +/- 0.41, respectively), lower m (1.3 +/- 1.2 vs 3.8 +/- 2.3 mu mol l(-1) min(-1)) and blunted hyperaemia (Delta TSI 6.8 +/- 2.9 vs 9.5 +/- 3.4) compared with controls (p < 0.01). Despite similar handgrip strength in the GDM and control groups (29.1 +/- 8.1 vs 26.2 +/- 10.4 kg, respectively), during repeated forearm contractions, women with GDM presented a blunted TSI response (6.5 +/- 3.9 vs 19.2 +/- 10.9; p < 0.01) and a reduced capacity to maintain the predetermined handgrip (23.4 +/- 2.9 vs 27.4 +/- 3.8%, p < 0.05). NIRS indices correlated with PWV, 24 h BP and blood glucose concentration earlier in pregnancy (r = 0.40-0.60; p < 0.05).Women with GDM exhibited a characteristic blunted TSI curve, showing alterations in muscle oxygenation and microvascular responsiveness compared with women with uncomplicated pregnancies. These alterations were manifested during exercise and possibly contribute to the reduced exercise tolerance in GDM. NIRS indices correlated with macrovascular indices (arterial stiffness) and 24 h BP.