2型糖尿病患者血管舒张功能和一氧化氮释放变化及与动脉硬化的关系

目的　探讨 2型糖尿病患者血管舒张功能和一氧化氮释放与糖尿病血管病变的关系。方法　选择 2 0名正常人 (对照组 )和 62例 2型糖尿病患者 (糖尿病组 ) ,并根据患者是否合并冠心病进行分组分析。采用高频超声方法测定反应性充血试验和口服硝酸甘油前后的肱动脉内径变化 ,以反映血管内皮依赖性和非内皮依赖性舒张功能 ,以及静脉闭塞试验测定一氧化氮储备释放 ,同时利用超声方法检测颈总动脉内膜厚度。结果　与对照组比较 ,糖尿病组的非内皮依赖性血管舒张功能无显著变化 (P >0 .0 5 ) ,而内皮依赖性血管舒张功能和内皮一氧化氮释放明显低下 (P<0 .0 5～ 0 .0 1) ,颈总动脉内膜厚度明显增厚 (P <0 .0 1)。糖尿病合并冠心病患者血管内皮依赖性和非内皮依赖性舒张功能均较非合并冠心病患者明显低下。结论　高频超声检测方法能够较好地判断糖尿病患者血管舒张功能。糖尿病患者存在明显的动脉硬化和因一氧化氮释放减少而出现的内皮依赖性舒张功能障碍 ,此与糖尿病性血管病变密切相关

Alterations in vasodilation and the capacity of endothelium to release endothelial nitrogen monoxide,and its relationship with atherosclerosis in patients with diabetes mellitus

Objective To evaluate the association of vasodilation and endothelial nitrogen monoxide(NO)release with diabetic angiopathy.Methods Brachial artery diameter was measured at baseline,during postocclusion reactive hyperemia(flow-mediated endothelium-dependent),and after sublingual nitroglycerol(endothelium-independent)using a high resolution ultrasound technique in 20 control subjects and 62 patients with type 2 diabetes mellitus.Vasodilation was expressed as the percentage change relative to the baseline diameter.The capacity of vascular endothelium to release NO was examined by venous occlusion of the upper arm.Endothelial NO release was expressed as the percentage change relative to the baseline NO level.Intima-medial thickness of the right carotid artery was measured using ultrasound imaging.According to whether they had got coronary artery disease patients were divided into subgroups. Results There was no significant difference in endothelium-independent vasodilation between control subjects and diabetics(P>0.05),there were significent reductions in endothelium-dependent vasodilation(P<0.05),endothelial NO release(P<0.01)and increase in intima-medial thickness of the carotid artery(P<0.01)in diabetics compared with that in control subjects.In diabetics with coronary artery disease(CAD),endothelium-dependent and endothelium-independent vasodilation were significantly reduced compared with that in diabetics without CAD(P<0.05,P<0.01).There were no significant correlations between vasodilation and HbA1c,diabetes duration, endothelial NO release,intima-medial thickness in diabetics. Conclusions Endothelial vasodilation can be detected relative good using ultrasound technique in patients with diabetes mellitus.There are significant impaired endothelium-dependent vasodilation and endothelial NO release in patients with diabetes mellitus,which are related close to atherosclerosis.