Improvement in coronary endothelial function is independently associated with a slowed progression of coronary artery calcification in type 2 diabetes mellitus.
Improvement in coronary endothelial function is independently associated with a slowed progression of coronary artery calcification in type 2 diabetes mellitus.
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冠状动脉内皮功能的改善与 2 型糖尿病冠状动脉钙化进展减缓独立相关。
DOI：
10.1093/eurheartj/ehp482
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发表时间：
2009
影响因子：
39.3
通讯作者：
Schelbert,HeinrichR
中科院分区：
文献类型：
--
作者：
Schindler,ThomasH;Cadenas,Jerson;Facta,AlvaroD;Li,Yanjie;Olschewski,Manfred;Sayre,James;Goldin,Jonathan;Schelbert,HeinrichR
目的探讨2型糖尿病（DM）患者1年随访（FU）后，降糖治疗引起的动脉壁结构和功能改变之间的关系。方法和结果在DM组（n= 22）和健康对照组（n= 17）中，采用电子束断层扫描评估冠状动脉钙化（CAC），超声评估颈动脉内膜中层厚度（IMT），而冠状动脉功能则通过正电子发射断层扫描测量静息时、冷加压试验（CPT）期间和腺苷刺激期间基线和FU后的心肌血流量（MBF）确定。糖尿病患者平均随访14 ± 1.9个月后血糖下降与CAC和颈动脉IMT进展缓慢相关（r= 0.48，P ≤ 0.036和r = 0.46，P ≤ 0.055），与CPT和腺苷的内皮相关ΔMBF改善相关（r= 0.46，P ≤ 0.038和r = 0.36，P ≤ 0.056）。通过多变量分析调整代谢参数后，降糖治疗后ΔMBF相对CPT的增加仍然是CAC进展的统计学显著独立预测因素（单因素方差分析P≤ 0.001）。结论糖尿病患者的降糖治疗可能对血管壁的结构和功能产生有利影响，而观察到的内皮相关冠状动脉功能的改善也可能介导对CAC进展的直接预防作用。
AimsTo examine a relationship between alterations of structure and function of the arterial wall in response to glucose-lowering therapy in type 2 diabetes mellitus (DM) after a 1-year follow-up (FU).Methods and resultsIn DM (n= 22) and in healthy controls (n= 17), coronary artery calcification (CAC) was assessed with electron beam tomography and carotid intima–media thickness (IMT) with ultrasound, whereas coronary function was determined with positron emission tomography-measured myocardial blood flow (MBF) at rest, during cold pressor testing (CPT), and during adenosine stimulation at baseline and after FU. The decrease in plasma glucose in DM after a mean FU of 14 ± 1.9 months correlated with a lower progression of CAC and carotid IMT (r= 0.48,P≤ 0.036 andr= 0.46,P≤ 0.055) and with an improvement in endothelium-related ΔMBF to CPT and to adenosine (r= 0.46,P≤ 0.038 andr= 0.36,P≤ 0.056). After adjusting for metabolic parameters by multivariate analysis, the increases in ΔMBF to CPT after glucose-lowering treatment remained a statistically significant independent predictor of the progression of CAC (P≤ 0.001 by one-way analysis of variance).ConclusionIn DM, glucose-lowering treatment may beneficially affect structure and function of the vascular wall, whereas the observed improvement in endothelium-related coronary artery function may also mediate direct preventive effects on the progression of CAC.