Cerebrovascular Reactivity, Intima-Media Thickness, and Nephropathy Presence in Patients with Type 1 Diabetes
Cerebrovascular Reactivity, Intima-Media Thickness, and Nephropathy Presence in Patients with Type 1 Diabetes
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DOI：
10.2337/dc08-1805
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发表时间：
2009-05-01
期刊：
影响因子：
16.2
通讯作者：
Bieniaszewski, Leszek
中科院分区：
文献类型：
--
作者：
Kozera, Grzegorz M.;Wolnik, Bogumil;Bieniaszewski, Leszek
目的：脑血管反应性损伤被认为是长期1型糖尿病患者脑微血管病变的标志。内膜-中膜复合体增厚反映1型糖尿病大血管病变的早期阶段。分析这些变量与其他微血管病变并发症之间的关系可以作为这些患者早期预防的有益指标。研究设计与方法：采用经颅内多普勒测量59例无脑血管事件史的1型糖尿病患者（中位年龄32.0岁，范围20-51岁，女性36例）和30例健康对照者（中位年龄31.5岁，范围25-39岁，女性15例）大脑中动脉血管舒缩反应储备（VMRr）和屏气指数（BHI）。分析1型糖尿病部分血管并发症的存在与患者生化指标、内膜-中膜厚度（IMT）、VMRr和BHI的关系。结果- 1型糖尿病患者的VMRr和BHI低于健康对照组（分别为81.5比100%，P < 0.01, 1.6比2.2,P = 0.04），而IMT显著高于健康对照组（0.36比0.30 mm, P = 0.001）。然而，没有发现IMT与VMRr的关联。我们发现糖尿病肾病患者的VMRr和BHI显著降低。结论：糖尿病肾病的存在，而不是IMT的存在，可以被视为1型糖尿病患者脑微血管病变严重程度的一个指标。
OBJECTIVE- Cerebrovascular reactivity impairment was reported as a marker of cerebral microangiopathy in long-term type 1 diabetes. Intima-media complex thickening reflects early stages of macroangiopathy in type 1 diabetes. The analysis of the relationship between these variables and other microangiopathic complications might serve as a beneficial indicator for early prophylaxis in these patients.RESEARCH DESIGN AND METHODS- vasomotor reactivity reserve (VMRr) and breath-holding index (BHI) of the middle cerebral artery were measured with transcranial Doppler in 59 patients (median age 32.0 years, range 20-51, 36 females) with type 1 diabetes, without history of cerebrovascular events, and 30 healthy control subjects (median age 31.5 years, range 25-39, 15 females). The relationships between the presence of selected vascular complications of type 1 diabetes and biochemical parameters, intima-media thickness (IMT), and VMRr and BHI in patients were analyzed.RESULTS- VMRr and BHI were lower in patients with type 1 diabetes when compared with healthy subjects (81.5 vs. 100%, P < 0.01, and 1.6 vs. 2.2, P = 0.04, respectively), whereas IMT was significantly higher in patients then in healthy control subjects (0.36 vs. 0.30 mm, P = 0.001). However, no association of IMT with VMRr was found. We found a significant reduction of VMRr and BHI in patients with diabetic nephropathy.CONCLUSIONS- The presence of diabetic nephropathy, but not IMT, can be regarded as an indicator of cerebral microangiopathy severity in patients with type 1 diabetes.