Indirect Assessment of Endothelial Function in Patients with Hypertension and Diabetes Mellitus

Bassam Al-Gailani, Kahtan Hamed, Seyhood Gafil, Al-Shujiri
2005 ‫اﻟﺜﺎﻧﻲ‬ ‫اﻟﻤﺠﻠﺪ‬-‫اﻻول‬ ‫اﻟﻌﺪد‬ Medical Journal of Babylon   unpublished
Thirty eight participants (27 men, 11 women) with age between 40-60 years were divided into 3 groups. Group I: Includes 13 healthy subjects. Group II: Includes 13 patients with essential hypertension. Group III: Includes 12 patients with type 2 diabetes mellitus. Using high-resolution ultrasound, brachial artery diameters at rest, during reactive hyperaemia (endothelium-dependent dilation] and after sublingual glyceryl trinitrate (GTN) application (endothelium-independent dilation) were
more » ... ation) were measured. The percentage increase of brachial artery diameter after reactive hyperemia (flow-mediated diltation% or FMD%) in control subjects was 8.85 ± 0.25% while it was found to decrease significantly (P<0.0001) in hypertensive and diabetic patients by 60% and 67% respectively. Furthermore, the percentage increase of the brachial artery diameter after glyceryl trinitrate (glyceryl trinitrate-induced dilatation% or GTNID %) in control healthy subjects was 14.41 ± 0.81%. The GTNID% was found to decrease significantly (P < 0.006)by 25% in hypertensive patients. No significant GTNID% change was found in diabetic patients. The antioxidant-oxidant ratio index (RI)of the measured biochemical parameters was significantly lower in hypertensive patients (by 50%)and even more lower in diabetic patients (by 84%) The antioxidant-oxidant RI was found to be significantly and posiviely correlated with FMD% and GTNID% in diabetic patients only. ‫ﺍ‬ ‫ﻟ‬ ‫ﺨﻼﺼﺔ‬ 38 ،‫ﻤﺸﺎﺭﻙ‬ 27 ‫ﻭ‬ ‫ﺫﻜﺭ‬ 11 ‫ﺒﻴﻥ‬ ‫ﺍﻋﻤﺎﺭﻫﻡ‬ ‫ﺘﺭﺍﻭﺤﺕ‬ ، ‫ﺍﻨﺜﻰ‬ 40-60 ‫ﻤﺠﺎﻤﻴﻊ‬ ‫ﺜﻼﺜﺔ‬ ‫ﻓﻲ‬ ‫ﻗﺴﻤﻭﺍ‬ ،‫ﺴﻨﺔ‬. ‫ﺍﻻﻭﻟـﻰ‬ ‫ﺍﻟﻤﺠﻤﻭﻋﺔ‬ : ‫ﺘـﺸﻤل‬ 13 ‫ﺴﻠﻴﻡ‬ ‫ﺸﺨﺹ‬. ‫ﺍﻟﻤﺠ‬ ‫ﺍﻟﺜﺎﻨﻴﺔ‬ ‫ﻤﻭﻋﺔ‬ : ‫ﺘﺸﻤل‬ 13 ‫ﺍﻻﻭﻟﻲ‬ ‫ﺍﻟﻀﻐﻁ‬ ‫ﺒﻔﺭﻁ‬ ‫ﻤﺭﻴﺽ‬. ‫ﺍﻟﺜﺎﻟﺜﺔ‬ ‫ﺍﻟﻤﺠﻤﻭﻋﺔ‬ : ‫ﺘﺘﻀﻤﻥ‬ 12 ‫ﻤﻌﺘﻤﺩ‬ ‫ﺍﻟﻐﻴﺭ‬ ‫ﺍﻟﺴﻜﺭ‬ ‫ﺒﺩﺍﺀ‬ ‫ﻤﺭﻴﺽ‬ ‫ﺍﻻﻨﺴﻭﻟﻴﻥ‬ ‫ﻋﻠﻰ‬. ‫ﺍﻟﺘﻔﺎﻋﻠﻲ‬ ‫ﺍﻻﺤﺘﻘﺎﻥ‬ ‫ﺘﺤﻔﻴﺯ‬ ‫ﻭﺨﻼل‬ ،‫ﺍﻟﺭﺍﺤﺔ‬ ‫ﻋﻨﺩ‬ ‫ﺍﻟﻌﻀﺩﻱ‬ ‫ﺍﻟﺸﺭﻴﺎﻥ‬ ‫ﻗﻁﺭ‬ ‫ﻗﻴﺎﺱ‬ ‫ﺘﻡ‬ ‫ﺍﻟﺼﻭﺘﻴﺔ‬ ‫ﻓﻭﻕ‬ ‫ﻟﻼﻤﻭﺍﺝ‬ ‫ﻋﺎﻟﻲ‬ ‫ﺜﺒﺎﺕ‬ ‫ﺒﺎﺴﺘﻌﻤﺎل‬) ‫ﺍﻟﺘﻭﺴﻊ‬ ‫ﺍﻟﺨﻼﻴ‬ ‫ﻋﻠﻰ‬ ‫ﺍﻟﻤﻌﺘﻤﺩ‬ ‫ﺍﻟﻁﻼﺌﻴﺔ‬ ‫ﺎ‬ (‫ﺍﻟﻠﺴﺎﻥ‬ ‫ﺘﺤﺕ‬ ‫ﺘﺭﺍﻴﻨﺘﺭﻴﺕ‬ ‫ﻜﻠﻴﺴﻴﺭﻴل‬ ‫ﻭﺒﺎﺴﺘﺨﺩﺍﻡ‬ ،) ‫ﺍﻟﻁﻼﺌﻴﺔ‬ ‫ﺍﻟﺨﻼﻴﺎ‬ ‫ﻋﻠﻰ‬ ‫ﻤﻌﺘﻤﺩ‬ ‫ﺍﻟﻐﻴﺭ‬ ‫ﺍﻟﺘﻭﺴﻊ‬ (‫ﺒﻤﻘﺩﺍﺭ‬ ‫ﺍﻟﺴﻠﻴﻤﻴﻥ‬ ‫ﺍﻻﺸﺨﺎﺹ‬ ‫ﻟﺩﻯ‬ ‫ﺍﻟﺘﻔﺎﻋﻠﻲ‬ ‫ﺍﻻﺤﺘﻘﺎﻥ‬ ‫ﺘﺤﻔﻴﺯ‬ ‫ﺒﻌﺩ‬ ‫ﺍﻟﻌﻀﺩﻱ‬ ‫ﺍﻟﺸﺭﻴﺎﻥ‬ ‫ﻗﻁﺭ‬ ‫ﻨﺴﺒﺔ‬ ‫ﺘﺯﺩﺍﺩ‬ 0.25% ± 8.85 ‫ﻭﺠـﺩﺕ‬ ‫ﺒﻴﻨﻤﺎ‬ ‫ﻤﻌﻨﻭﻱ‬ ‫ﺒﺸﻜل‬ ‫ﻤﻨﺨﻔﻀﺔ‬) 0.0001 P < (‫ﺍﻟ‬ ‫ﺍﻟﻤﺭﻀﻰ‬ ‫ﻟﺩﻯ‬ ‫ﺒﻨﺴﺒﺔ‬ ‫ﺍﻟﺴﻜﺭﻱ‬ ‫ﻭﺩﺍﺀ‬ ‫ﺍﻟﻀﻐﻁ‬ ‫ﺒﻔﺭﻁ‬ ‫ﻤﺼﺎﺒﻴﻥ‬ % 60 ‫ﻭ‬ % 67 ‫ﺍﻟﺘـﻭﺍﻟﻲ‬ ‫ﻋﻠـﻰ‬. ‫ﺘﺭﺍﻴﻨﺘﺭﻴﺕ‬ ‫ﻜﻠﻴﻴﺴﻴﺭﻴل‬ ‫ﺍﺨﺫ‬ ‫ﺒﻌﺩ‬ ‫ﺍﻟﻌﻀﺩﻱ‬ ‫ﺍﻟﺸﺭﻴﺎﻥ‬ ‫ﻗﻁﺭ‬ ‫ﻨﺴﺒﺔ‬ ‫ﺘﺯﺩﺍﺩ‬ ،‫ﺫﻟﻙ‬ ‫ﻋﻠﻰ‬ ‫ﻋﻼﻭﺓ‬) ‫ﻴﻨﺘﺭﻴﺕ‬ ‫ﺘﺭﺍ‬ ‫ﻜﻠﻴﺴﻴﺭﻴل‬ ‫ﻗﺒل‬ ‫ﻤﻥ‬ ‫ﺍﻟﻤﺤﻔﺯ‬ ‫ﺍﻟﺘﻭﺴﻊ‬ [ ‫ﻓـﻲ‬ ‫اﻟﻄﺒﯿﺔ‬ ‫ﺑﺎﺑﻞ‬ ‫ﻣﺠﻠﺔ‬ 2005-‫اﻟﺜﺎﻧﻲ‬ ‫اﻟﻤﺠﻠﺪ‬-‫اﻻول‬ ‫اﻟﻌﺪد‬ Medical Journal of Babylon-2005 Volume 2 No.1 ‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ ‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ‬ 51 ‫ﺒﻤﻘﺩﺍﺭ‬ ‫ﺍﻟﺴﻠﻴﻤﻴﻥ‬ ‫ﺍﻻﺸﺨﺎﺹ‬ 0.81% + 14.41. ‫ﻤﻌﻨﻭﻱ‬ ‫ﺒﺸﻜل‬ ‫ﺍﻟﺘﻭﺴﻊ‬ ‫ﻫﺫﺍ‬ ‫ﻭﻴﻘل‬) (P < 0.006 ‫ﺒﻨﺴﺒﺔ‬ %25 ‫ﺍﻟﻀﻐﻁ‬ ‫ﻓﺭﻁ‬ ‫ﻤﺭﻀﻰ‬ ‫ﻟﺩﻯ‬. ‫ﺍﻟﺴﻜﺭﻱ‬ ‫ﺩﺍﺀ‬ ‫ﻤﺭﻀﻰ‬ ‫ﻟﺩﻯ‬ ‫ﻤﻌﻨﻭﻱ‬ ‫ﺘﻐﻴﺭ‬ ‫ﻴﻭﺠﺩ‬ ‫ﻭﻻ‬. ‫ﺍﻟﻀﻐﻁ‬ ‫ﻓﺭﻁ‬ ‫ﻤﺭﻀﻰ‬ ‫ﻟﺩﻯ‬ ‫ﻫﺎﻡ‬ ‫ﺒﺸﻜل‬ ‫ﻴﻘل‬ ‫ﺍﻟﻜﻴﻤﻴﺎﺌﻴﺔ‬ ‫ﺍﺍﻟﺤﻴﺎﺘﻴﺔ‬ ‫ﻟﻠﻘﻴﻡ‬ ‫ﺍﻟﻤﺅﻜﺴﺩﺓ‬ ‫ﺍﻟﻤﺎﺩﺓ‬ ‫ﺍﻟﻰ‬ ‫ﻟﻸﻜﺴﺩﺓ‬ ‫ﺍﻟﻤﻘﺎﻭﻤﺔ‬ ‫ﻟﻠﻤﺎﺩﺓ‬ ‫ﺍﻟﺘﻨﺎﺴﺒﻲ‬ ‫ﺍﻟﻤﻌﺎﻤل‬ ‫ﺒﻨﺴﺒﺔ‬ % 50 ‫ﺒﻨ‬ ‫ﺍﻟﺴﻜﺭﻱ‬ ‫ﺩﺍﺀ‬ ‫ﻤﺭﻀﻰ‬ ‫ﻟﺩﻯ‬ ‫ﻜﺒﻴﺭ‬ ‫ﺒﺸﻜل‬ ‫ﻭﻴﻘل‬ ‫ﺴﺒﺔ‬ % 84. ‫ﺍﻟﻤﻌﺘﻤﺩ‬ ‫ﺍﻟﻌﻀﺩﻱ‬ ‫ﺍﻟﺸﺭﻴﺎﻥ‬ ‫ﺘﻭﺴﻊ‬ ‫ﻤﻊ‬ ‫ﻫﺎﻤﺔ‬ ‫ﻁﺭﺩﻴﺔ‬ ‫ﻋﻼﻗﺔ‬ ‫ﻟﻪ‬ ‫ﺍﻟﻤﺅﻜﺴﺩﺓ‬ ‫ﺍﻟﻤﺎﺩﺓ‬ ‫ﺍﻟﻰ‬ ‫ﻟﻸﻜﺴﺩﺓ‬ ‫ﺍﻟﻤﻘﺎﻭﻤﺔ‬ ‫ﻟﻠﻤﺎﺩﺓ‬ ‫ﺍﻟﺘﻨﺎﺴﺒﻲ‬ ‫ﺍﻟﻤﻌﺎﻤل‬ ‫ﺃﻥ‬ ‫ﻭﺠﺩ‬ ‫ﺍﻟﻀﻐﻁ‬ ‫ﻓﺭﻁ‬ ‫ﻤﺭﻀﻰ‬ ‫ﻟﺩﻯ‬ ‫ﺘﺭﺍﻴﻨﺘﺭﻴﺕ‬ ‫ﻜﻠﻴﺴﻴﺭﻴل‬ ‫ﺒﻭﺍﺴﻁﺔ‬ ‫ﺍﻟﻤﺤﻔﺯ‬ ‫ﻭﺍﻟﺘﻭﺴﻊ‬ ‫ﺍﻟﻁﻼﺌﻴﺔ‬ ‫ﺍﻟﺨﻼﻴﺎ‬ ‫ﻋﻠﻰ‬. ‫ـــــــــــــــــــــــــــــــــــ‬ ‫ــــــــــــــــــــــــ‬ ‫ــــــــ‬
fatcat:t6ru7woforaatnpvu4agbnup7y