Клинико-диагностическое значение индекса толщины интима-медиа при сахарном диабете 2 типа

Abstract

Background: The cardiovascular changes are the cause of the most serious and fatal type 2 diabetes complications. Therefore it's of great importance to study the features of the development of these alternations, to select simple diagnostic criterion to indicate systemic lesion in bloodstream and efficacy of treatment. Objective: We designed this study in order to determine the effect of impaired carbohydrate metabolism on intima-media thickness (IMT) in type 2 diabetes mellitus (T2DM). Methods: Of 36 participants ages 47-69 years (18 patients with T2DM and 18 normoglycemic hypertensive control subjects) matched for age and sex were included in this study. C-peptide, insulin (IRI), hemoglobin A1 c, and routine clinical parameters were determined at baseline. We used ultrasound system «Sonoline 60» connected with 10.5 MHz linear array transducer. ITM was measured on the far wall of both the right and left common carotid arteries over a length of 1 cm on the reference site located 2 cm below the bifurcation. The measurement on the left and right arteries were averaged to obtain a combined value for all two arteries. Statistical analyses were done using software package SPSS 13.0 for Windows. Results: Patient with T2DM had significantly higher carotid IMT (1,97±0,2 versus 1,6±0,8; p=0,0001), diffuse thickening of intima and significant vascular stenoses, moreover stenoses were disseminated in T2DM. IRI and HDL-C level showed a significant correlation (r=0,38, p=0,03 and r=0,41, p=0,02, respectively) with IMT in patient with T2DM. IRI level was independently related to IMT (6=0 38 t=2,1; p=0,04). Discussion: Identified by Doppler study abnormalities of the brachiocephalic vessels in T2DM, such as significant increase in IMT, allow to speculate about several crucial issues of diagnostics and treatment. Thus, firstly, taking into account disseminated type of arteriostenoses, we are justified to suppose that there is the substantial restriction of the collateral circulation development. Secondly, in view of diffuse type of vascular lesion, we considered transcranial Doppler ultrasonography by «blind» methods, which not are able to evaluate the flow gradients, to be not informative. In the third place, we can objective estimate the efficacy of the treatment aimed at endothelial dysfunction reduction by means of the ITM assessment.

Цель исследования: оценить влияние нарушений углеводного обмена на состояние ИТИМ при СД 2 типа. Результаты: У сопоставимых по возрасту, уровню 0Х, С-пептида и АД ср. 18 больных СД 2 типа и 18 пациентов с АГ без нарушений углеводного обмена исследовано состояние ИТИМ общих сонных артерий с помощью 2-мерной ультразвуковой визуализирующей системы с высоким разрешением «Sonoline 60». Установлено более существенное увеличение ИТИМ, диффузное утолщение интимы и значительное сужение просвета сосудов, к тому же носившее при СД 2 типа системный характер. Высказывается критическое отношение к диагностическим возможностям ТК УЗДГ «слепым» Доплером и мнение о целесообразности определения ИТИМ для оценки влияния терапии на функцию эндотелия.