Correlations between endothelial function in the systemic and cerebral circulation and insulin resistance in type 2 diabetes mellitus
Correlations between endothelial function in the systemic and cerebral circulation and insulin resistance in type 2 diabetes mellitus
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DOI：
10.1177/1479164115604120
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发表时间：
2016-01-01
影响因子：
2.4
通讯作者：
Deepak, Kishore K.
中科院分区：
文献类型：
--
作者：
Prakash, Kiran;Chandran, Dinu S.;Deepak, Kishore K.
胰岛素抵抗与2型糖尿病的内皮功能障碍有关，其可导致体循环和脑循环的血管反应性受损。对非内皮依赖性全身效应的血管反应性结果进行适当的“校正”，可避免对内皮功能的误解。因此，我们“校正”了血管反应性结果，并探讨了全身血管反应性、脑血管反应性和胰岛素抵抗之间的潜在相关性。在34例患者中，通过定量反应性充血评估“全身血管反应性”。通过定量高碳酸血症期间脑血流速度的变化来评估脑血管反应性。为了尽量减少非内皮依赖性全身效应对血管反应性结果的影响，通过使用对侧的测量值标准化全身血管反应性来计算“校正的全身血管反应性”;通过计算脑血管传导指数的百分比和绝对变化来校正脑血管反应性结果（分别为“百分比脑血管传导指数”和“δ脑血管传导指数”）。通过稳态模型评估来估计胰岛素抵抗。常规脑血管反应性与全身血管反应性之间的相关性不显著。但“校正的全身血管反应性”与“脑血管传导指数百分比”（r=0.51; p=0.002）和“校正的全身血管反应性”与“δ脑血管传导指数”（r=0.50; p=0.003）之间的相关性是显著的。在所有血管反应性参数中，只有“δ脑血管传导指数”与胰岛素抵抗的稳态模型评估显著相关（r=-0.38; p=0.029）。总之，在体循环和脑循环中的内皮功能是适度相关的，只要血管反应性估计校正非内皮依赖性的影响。
Insulin resistance is associated with endothelial dysfunction in type 2 diabetes mellitus, which can lead to impaired vascular reactivities of both systemic and cerebral circulations. Appropriate 'correction' of vascular reactivity results for non-endothelium-dependent systemic effects avoids misinterpretation of endothelial function. Therefore, we 'corrected' vascular reactivity results and explored the potential correlations between systemic vascular reactivity, cerebrovascular reactivity and insulin resistance. In 34 patients, 'systemic vascular reactivity' was assessed by quantifying reactive hyperaemia. Cerebrovascular reactivity was assessed by quantifying changes in cerebral blood flow velocity during hypercapnia. To minimize the influence of non-endothelium-dependent systemic effects on vascular reactivity results, 'corrected systemic vascular reactivity' was calculated by normalizing systemic vascular reactivity using the measurements from the contralateral side; and cerebrovascular reactivity results were corrected by calculating percentage and absolute changes in cerebrovascular conductance index ('percent cerebrovascular conductance index' and 'delta cerebrovascular conductance index', respectively). Insulin resistance was estimated by homeostatic model assessment. Correlation between conventional cerebrovascular reactivity and systemic vascular reactivity was not significant. But correlations between 'corrected systemic vascular reactivity' and 'percent cerebrovascular conductance index' (r=0.51; p=0.002) and 'corrected systemic vascular reactivity' and 'delta cerebrovascular conductance index' (r=0.50; p=0.003) were significant. Among all vascular reactivity parameters, only 'delta cerebrovascular conductance index' was significantly correlated with homeostatic model assessment of insulin resistance (r=-0.38; p=0.029). In conclusion, endothelial function in the systemic and cerebral circulations is moderately correlated, provided that vascular reactivity estimates are corrected for non-endothelium-dependent influences.