Enhancement of endothelial function by pregnancy - Inadequate response in women with type 1 diabetes
Enhancement of endothelial function by pregnancy - Inadequate response in women with type 1 diabetes
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DOI：
10.2337/diacare.26.2.475
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发表时间：
2003-02-01
期刊：
影响因子：
16.2
通讯作者：
Sattar, N
中科院分区：
文献类型：
--
作者：
Ramsay, JE;Simms, RJ;Sattar, N
目的：患有I型糖尿病的孕妇发生血管并发症的风险显著增加。我们的目的是研究I型糖尿病妇女产前和产后期间的血管功能、代谢和炎症危险因素，并与健康对照组进行比较。研究设计和方法--15名糖尿病妇女和30名对照组在妊娠晚期被纳入研究。在这些妇女中，9名病例受试者和16名对照受试者在出生后进行了重新调查。结果：对照组(乙酰胆碱，P=0.018；硝普钠，P=0.01)和糖尿病妇女(乙酰胆碱，P=0.029；硝普钠，P=0.105)在妊娠期的微血管反应均好于产后，而糖尿病妇女在两个时期的反应均显著低于对照组(均P<；0.001，双向方差分析)。尽管脂蛋白谱相似，这种功能障碍还是存在的。通过调整两组受试者中HBA(1c)的差异，但C反应蛋白浓度的差异，患者和对照组之间的血管响应性差异显著减弱。结论妊娠增强了微血管功能，但在糖尿病女性中，这种改善不足以达到健康非妊娠女性的反应。这表明患有I型糖尿病的年轻女性存在持续性血管缺陷，可能导致不良妊娠结局。我们的数据表明，高血糖的慢性影响在这类女性的血管反应性受损中起到了作用。
OBJECTIVE - Pregnant women with type I diabetes have a substantially increased risk of vascular complications. Our aim was to study vascular function and metabolic and inflammatory risk factors during the antenatal and postpartum periods in women with type I diabetes compared with healthy control subjects.RESEARCH DESIGN AND METHODS - A total of 15 women with diabetes and 30 control subjects were recruited in the third trimester of pregnancy. Of these women, 9 case subjects and 16 control subjects were reinvestigated in the postnatal period. Blood samples were collected and microvascular skin perfusion was assessed in vivo using laser Doppler imaging and iontophoretic administration of endothelial-dependent (acetylcholine [ACH]) and endothelial-independent (sodium nitroprusside [SNP]) vasodilators.RESULTS - Microvascular responses in both control subjects (ACH, P = 0.018; SNP, P = 0.01) and diabetic women (ACH, P = 0.029; SNP, P = 0.105) were better during pregnancy than in the postnatal period, although responses in women with diabetes were significantly inferior to those in control subjects during both periods (all P < 0.001, two-way ANOVA). This dysfunction existed despite similar lipoprotein profiles. The difference in vascular responsivity between case and control subjects was significantly attenuated by adjustment for differences in HbA(1c) but not C-reactive protein concentrations in the two groups.CONCLUSIONS - Pregnancy enhances microvascular function, but in women with diabetes, such improvements are insufficient to attain responses seen in healthy nonpregnant women. This suggests a persistent vascular defect in young women with type I diabetes that may contribute to adverse pregnancy outcome. Our data suggest a role for the chronic effects of hyperglycemia in the impaired vascular responsiveness in such women.