Assessment of vasomotor endothelial function inpatients with diabetes mellitus type l at different stages ofdiabetic nephropathy


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Aim. To study a vasomotor endothelial function in patients with diabetes mellitus (DM) type 1 at different
stages of diabetic nephropathy (DN).
Material and methods. Twenty six patients with DM type 1(11 males and 15 females, mean age
25.9 ±4.3 years, mean history of DM 12.9 + 3.4 years) entered the study. They were divided into 4
groups: group 1 -without renal affection, group 2 - with microalbuminuria (MAU), group 3 - with
proteinuria (PU), group 4 - with chronic renal failure (CRF). The control group consisted of 7
healthy volunteers. Endothelium-dependent vasodilation (EDVD) was studied in the test with reactive
hyperemia provoked by 4-5 min occlusion of the brachial artery by pneumocollar and subsequent assessment
of arterial diameter changes after decompression using high-resolution ultrasound dopplerography.

Results. Reactive hyperemia resulted in dilation of the artery in all the examinees. This dilation was
maximal on second 30 after removal of the collar in the controls, group 2, 3 and 4 and reached
9.2 ± 2.9, 9.63 ± 3.62, 7.25 ± 5.23 and 4.42 ± 4.05%, respectively. Resting blood flow velocity was
similar in all the groups and rose maximally by 95-150%. To estimate EDVD of the brachial artery
more precisely, the coefficient of endothelial sensitivity to shift tension was calculated. It made up
0.084 ± 0.04 (control group), 0.0825 + 0.08 (group 1), 0.138 ± 0.07(group 2), 0.067 ± 0.05 (group
3) and 0.052 ± 0.04 (group 4).
Conclusion. At the earliest stage of DN (stage MAU), EDVD is not affected as maximal vasodilation
of the brachial artery and endothelial sensitivity to shift tension do not differ from the control values.
This means that the stage of MAU is reversible in early treatment, but PU and CRF are not reversible
stages associated with depletion of endothelial cells and loss of sensitivity to changing hemodynamic
conditions.

参考

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