Microcirculatory disorders in patients with coronary heart disease and type 2 diabetes
摘要
In patients with coronary artery disease (CAD) and those who suffer from second type diabetes mellitus micro vascular disorders was found. Diabetes is associated with an increased risk of cardiovascular events. It might be due to micro vascular changes. We hypothesized that patients with CAD and CAD with diabetes mellitus (CAD DM) have differences in structural and functional condition of microcirculation. We studied 50 patients with CAD, 43 CAD DM patients and 34 healthy controls. Digital photoplethysmography, computer nail fold videocapillaroscopy at baseline, after postocclusive hyperemia and during venous congestion were performed. We evaluated functional (occlusion index (IO)) and structural disorders (refl ection index (RI,%) of arterioles. The structure of coetaneous capillaries by capillary density (CD, cap/mm2) was assessed. Capillary function was estimated by percent perused capillaries (pPC,%). CAD and CAD DM patients had structural and functional changes of microcirculation. RI, IO and pPC in CAD and CAD DM patients were significantly different from controls (p<0.05), but there was no difference between CAD and CAD DM groups (p>0.6). CD in CAD DM group was significantly lower than in CAD and control groups (p< 0.019). The results show a decrease of micro vascular function in both CAD and CAD DM patients. CAD DM patients have also structural changes in capillary level.
关于作者
Yu. Belenkov
I.M. Sechenov First MSMU
俄罗斯联邦
俄罗斯联邦
E. Privalova
I.M. Sechenov First MSMU
俄罗斯联邦
俄罗斯联邦
A. Shchendrygina
I.M. Sechenov First MSMU
俄罗斯联邦
俄罗斯联邦
I. Chekneva
I.M. Sechenov First MSMU
俄罗斯联邦
俄罗斯联邦
T. Emelyanova
I.M. Sechenov First MSMU
俄罗斯联邦
俄罗斯联邦
参考
1. Bonetti P.O., Pumper G.M., Higano S.T. Noninvasive identifi cation of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia // J. Am. Coll. Cardiol. 2004; 44: 2137–2141.
2. Дедов И.И., Шестакова М.В., Александров А.А. Алгоритмы специализированной медицинской помощи больным сахарным диабетом // Сахарный диабет. 2011; 3: 2–71.
3. Роль дисфункции эндотелия в развитии диабетических макроангтопатий СД и ДЭ: Пособие для врачей / Под ред. Северина А.С., Галицина Н.А., Парфенова Е.В., Пахомова Е.А., Цоколева З.И., Велиткевич Е.А. М. 2007. С. 20.
4. Caballero A.E., Arora S., Saouaf R. et al. Micro and macrovascular reactivity is impaired in subjects at risk for type 2 diabetes // Diabetes. 1999; 48: 1863–1867.
5. Акчурин Р.С., Васюк Ю.А., Карпов Ю.А. и др. Национальные рекомендации по диагностике и лечению стабильной стенокардии // Кардиоваскулярная терапия и профилактика. 2008; 7(6): прил. 4.
6. Antonios T.F.T., Singer D.R.J., Markandu N.D. Rarefaction of skin capillaries in borderline essential hypertension suggests an early structural abnormality hypertension // Hypertension. 1999; 34: 655–658.
7. Cheng C., Daskalakis C., Falkner B. Capillary rarefaction in treated and untreated hypertensive subjects // Ther. Adv. Cardiovasc. Dis.; 2008; 2(2): 79–88.
8. Izjerman R.G., Jongh de R.T., Beij k M.A. et al. Individuals at increased coronary heart disease risk are characterized by an impaired microvascular function in skin // Eur. J. Clin. Invest. 2003; 33: 536–542.
9. Sax F.L., Hanson C. et al. Impaired forearm vasodilator reserve in patients with microvascular angina. Evidence of a generalized disorder of vascular function? // N. Engl. J. Med. 1987; 317: 1366–1370.
10. Antonios T.F.T., Singer D.R.J., Markandu et al. Structural skin capillary rarefaction in essential hypertension T // Hypertension. 1999; 33: 998–1001.
11. Durante W., Sunahara F.A., Sen A.K. Eff ect of diabetes on metabolic coronary dilatation in the rat // Cardiovasc. Res. 1989; 23: 40–45.
12. Skrha J., Prazny M., Haas T. et al. Comparison of laser-Doppler fl owmetry with biochemical indicators of endothelial dysfunction related to early microangiopathy in Type 1 diabetic patients // J. Diabetes Complications. 2001; 15: 234–240.
13. Koscielny J., Latza R., Wolf S. et al. Early rheological and microcirculatory changes in childrenwith type 1 diabetes mellitus // Clin. Hemorheol. Microcirc. 1998; 19.
14. Kawaguchi M., Techigawara M., Ishihata T. et al. A comparison of ultrastructural changes on endomyocardial biopsy specimens obtained from patients with diabetes mellitus with and without hypertension // Heart Vessels. 1997; 12: 267–274.
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