Coronary flow reserve is reduced in young men with IDDM
Coronary flow reserve is reduced in young men with IDDM
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DOI：
10.2337/diabetes.47.2.248
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发表时间：
1998-02-01
期刊：
影响因子：
7.7
通讯作者：
Knuuti, J
中科院分区：
文献类型：
--
作者：
Pitk채nen, OP;Nuutila, P;Knuuti, J
据报道，患有微血管并发症但没有阻塞性冠状动脉粥样硬化的糖尿病患者会出现冠状动脉循环障碍。本研究的目的是调查年轻的成年胰岛素依赖型糖尿病患者的冠状动脉血流储备，但没有微量白蛋白尿和糖尿病自主神经病变。对12例年龄30.0 ± 6.6岁的非吸烟男性胰岛素依赖型糖尿病患者和12例健康志愿者进行了冠状动脉血流储备测定。两组患者的血压和血脂水平相似，无冠心病家族史。IDDM患者的运动超声心动图和自主神经功能试验正常，5例患者有轻微的背景视网膜病变，无微量白蛋白尿。应用正电子发射断层扫描（PET）和[O-15]H（2）0测定了静息时和服用潘生丁后的心肌血Plow。研究在正常血糖高胰岛素血症（血清胰岛素接近70 mU/l）时进行。g（-1）。min（-1），NS）。与对照组相比，IDDM患者充血时的心肌血流量（3.17 ± 1.57）降低了29%（4.45 ± 1.37 ml）。g（-1）。min（-1），P < 0.05）。因此，冠状动脉现在储备糖尿病患者充血时与静息时的血流比值低于对照组（3.76 +/- 1.69 vs. 5.31 +/- 1.86，糖尿病组充血时冠脉总阻力明显高于对照组（P < 0.05）（53.7 ± 31.5）与对照组（31.4 ± 11.6 mmHg）相比。min . G .有或无轻度视网膜病变的糖尿病患者的冠状动脉血流储备相似。两组患者的冠状动脉血流储备与血脂或HbA（1c）值无相关性。这不可能！根据标准冠心病危险因素的解释，这些结果暗示了IDDM患者冠状动脉血管反应性的早期损害，这可能是未来冠心病的早期前兆或可能有助于糖尿病心肌病的发病机制。
Disturbances of coronary circulation have been reported in diabetic patients with microvascular complications hut without obstructive coronary atherosclerosis. The aim of the present study was to investigate coronary flow reserve in young adult patients with IDDM but without microalbuminuria and diabetic autonomic neuropathy. Coronary flow reserve was determined in 12 nonsmoking male patients with IDDM (age 30.0 +/- 6.6 years) and 12 healthy matched volunteers, Groups were similar with respect to blood pressure and serum lipid concentrations, and no subject had a positive family history of coronary heart disease. The patients with IDDM had normal exercise echocardiography and autonomic nervous function tests, Five patients had minimal background retinopathy, and none had microalbuminuria. Positron emission tomography and [O-15]H(2)0 were used to measure myocardial blood Plow at rest and after dipyridamole administration, The studies were performed during euglycemic hyperinsulinemia (serum insulin similar to 70 mU/l),The baseline myocardial blood flow was similar in patients with IDDM and in control subjects (0.84 +/- 0.18 vs, 0.88 +/- 0.25 ml . g(-1). min(-1), NS). The myocardial blood flow during hyperemia was 29% lower in patients with IDDM (3.17 +/- 1.57) compared with the control subjects (4.45 +/- 1.37 ml . g(-1). min(-1), P < 0.05). Consequently, coronary now reserve (the ratio of flow during hyperemia and at rest) was lower in diabetic patients than in control subjects (3.76 +/- 1.69 vs. 5.31 +/- 1.86, P < 0.05) and the total coronary resistance during hyperemia was higher in diabetic patients (53.7 +/- 31.5) compared with the control subjects (31.4 +/- 11.6 mmHg . min . g . ml(-1), P < 0.05), The coronary flow reserve was similar in diabetic patients with and without mild background retinopathy No association was found between the coronary flow reserve and serum lipid or HbA(1c) values in either group, Coronary flow reserve is impaired in yelling adult males with IDDM and no or minimal microvascular complications and without any evidence of coronary heart disease, This abnormality cannot be! explained by standard coronary heart disease risk factors, The results imply early impairment of coronary vascular reactivity in IDDM patients, which may represent an early precursor of future coronary heart disease or may contribute to the pathogenesis of diabetic cardiomyopathy.