Vascular reactivity and thiazolidinediones
Vascular reactivity and thiazolidinediones
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DOI：
10.1016/j.amjmed.2003.08.015
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发表时间：
2003-12-08
影响因子：
5.9
通讯作者：
Chaudhuri, A
中科院分区：
文献类型：
--
作者：
Dandona, P;Aljada, A;Chaudhuri, A
内皮功能障碍是糖尿病患者发生血管疾病的关键因素。血管张力和管腔直径的维持依赖于血管收缩力和血管舒张力的净平衡。在糖尿病和肥胖症中，血管反应性都是异常的。在缺血、二氧化碳刺激、热刺激或运动后，糖尿病患者没有表现出非糖尿病患者所观察到的血流量增加或血管舒张。异常反应性的机制可能包括内皮细胞和血管平滑肌。作用于血管平滑肌细胞的血管舒张因子主要有一氧化氮、前列环素和超极化因子。主要的血管收缩剂有内皮素、血管紧张素II、去甲肾上腺素、血清素和血栓素A(2)。在糖尿病患者中，血管收缩剂增加，血管扩张剂减少。噻唑烷二酮类药物（TZDs）可改善血管舒张反应，在血管疾病的治疗中具有重要意义。TZDs具有抗炎作用，在内皮水平上抑制游离脂肪酸和活性氧，这可能有助于改善患者的血管反应性。此外，从长期来看，TZDs的这些作用可能对降低动脉粥样硬化的发生率和严重程度有影响。(C) 2003年由摘录医学公司。
Endothelial dysfunction is a critical factor in the development of vascular disease in patients with diabetes mellitus. Maintenance of the vascular tone and luminal diameter of a blood vessel is dependent on the net balance of vasoconstrictor and vasodilator forces. In both diabetes and obesity, vascular reactivity is abnormal. After ischemia, carbon dioxide challenge, thermal challenge, or exercise, individuals with diabetes do not exhibit the increase in blood flow or vasodilation observed in persons without diabetes. The mechanisms involved in abnormal reactivity may include both the endothelium and vascular smooth muscle. Major vasodilator factors that act on vascular smooth muscle cells are nitric oxide, prostacyclin, and hyperpolarizing factor. The main vasoconstrictors are endothelin, angiotensin II, norepinephrine, serotonin, and thromboxane A(2). In patients with diabetes, there is an increase in vasoconstrictors and a decrease in vasodilators. Thiazolidinediones (TZDs) improve vasodilative responses, which may be of importance in the treatment of vascular disease. The TZDs have anti-inflammatory effects and suppress free fatty acids and reactive oxygen species at the endothelial level, which may contribute to the improved vascular reactivity observed in patients treated with these agents. In addition, these effects of TZDs may have implications for reducing the incidence and severity of atherosclerosis in the long term. (C) 2003 by Excerpta Medica, Inc.