Is visceral adiposity a modifier for the impact of blood pressure on arterial stiffness and albuminuria in patients with type 2 diabetes?
Is visceral adiposity a modifier for the impact of blood pressure on arterial stiffness and albuminuria in patients with type 2 diabetes?
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DOI：
10.1186/s12933-016-0335-3
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发表时间：
2016-01-21
影响因子：
9.3
通讯作者：
Ogawa Y
中科院分区：
文献类型：
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作者：
Bouchi R;Ohara N;Asakawa M;Nakano Y;Takeuchi T;Murakami M;Sasahara Y;Numasawa M;Minami I;Izumiyama H;Hashimoto K;Yoshimoto T;Ogawa Y
我们的目的是调查内脏肥胖是否可以改变血压对2型糖尿病患者动脉僵硬和蛋白尿的影响。这项横断面研究考察了内脏肥胖症与血压升高对动脉僵硬和蛋白尿的交互作用。纳入2型糖尿病患者638例(平均年龄12岁；女性占40%)。用双阻抗分析仪测量内脏脂肪面积(VFA，cm~2)，将患者分为VFA<100者(N=0.341)和VFA<≥<100者(N=0.297)。测定24小时尿蛋白定量(UAE，mg/d)，采用臂踝脉搏波传导速度(ba-pwv，cm/S)评价动脉硬化程度。用线性回归分析研究收缩压(SBP)和挥发性脂肪酸(VFA)与UAE和baPWV的关系。≥100型患者的血压、糖化血红蛋白、甘油三酯、尿白蛋白、丙氨酸氨基转移酶、C反应蛋白明显高于VFA型患者，高密度脂蛋白明显低于VFA型患者，糖尿病病程短于VFA100型患者。在对年龄、性别、糖化血红蛋白、糖尿病并发症、胰岛素和降压药的使用等协变量进行调整的多元回归分析中，VFA100(标准化β0.224，p=0.001)和VFA≥1100(标准化β0.196，p=0.004)患者的SBP与ba-PWV显著且几乎相等地相关。相比之下，在多元回归模型中，≥为100的患者(标准化β为0.263，p=0.001)的收缩压与UAE的关联性强于VFA为100的患者(标准化β为0.140，p=0.080)。在整个队列中，收缩压和挥发性脂肪酸在阿联酋(标准化β0.172，p=0.040)上存在显著的交互作用，而在ba-pwv(标准化β−0.008，p=0.916)上没有显著的交互作用。在内脏脂肪含量低和高的2型糖尿病患者中，血压升高对动脉僵硬的影响几乎是相似的，而后者与蛋白尿的相关性更强。
We aimed to investigate whether visceral adiposity could modify the impact of blood pressure on arterial stiffness and albuminuria in patients with type 2 diabetes. This cross-sectional study examines the interaction of visceral adiposity with increased blood pressure on arterial stiffness and albuminuria. 638 patients with type 2 diabetes (mean age 64 ± 12 years; 40 % female) were enrolled. Visceral fat area (VFA, cm2) was assessed by a dual-impedance analyzer, whereby patients were divided into those with VFA < 100 (N = 341) and those with VFA ≥ 100 (N = 297). Albuminuria was measured in a single 24-h urine collection (UAE, mg/day) and brachial-ankle pulse wave velocity (ba-PWV, cm/s) was used for the assessment of arterial stiffening. Linear regression analyses were used to investigate the association of systolic blood pressure (SBP) and VFA with UAE and baPWV. Patients with VFA ≥ 100 were significantly younger, had higher SBP, HbA1c, triglycerides, UAE, alanine aminotransferase, C-reactive protein and lower high-density lipoprotein and shorter duration of diabetes than those with VFA < 100. SBP was significantly and almost equivalently associated with ba-PWV both in VFA < 100 (standardized β 0.224, p = 0.001) and VFA ≥ 100 (standardized β 0.196, p = 0.004) patients in the multivariate regression analysis adjusting for covariates including age, gender, HbA1c, diabetic complications and the use of insulin and anti-hypertensive agents. By contrast, the association of SBP with UAE was stronger in patients with VFA ≥ 100 (standardized β 0.263, p = 0.001) than that in patients with VFA < 100 (standardized β 0.140, p = 0.080) in the multivariate regression model. In the whole cohort, the significant interaction between SBP and VFA on UAE (standardized β 0.172, p = 0.040) but not on ba-PWV (standardized β −0.008, p = 0.916) was observed. The effect of increased blood pressure on arterial stiffness is almost similar in type 2 diabetic patients with both low and high visceral adiposity, while its association with albuminuria is stronger in the latter.