scholarly journals INFLUENCE OF HORMONAL DISORDERS ON ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION AND COMORBIDE ENDOCRINOPATHIES

2019 ◽  
Vol 6 (3) ◽  
pp. 132-136
Author(s):  
O. Bilovol ◽  
V. Nemtsova ◽  
I. Ilchenko ◽  
V. Zlatkina

Abstract. INFLUENCE OF HORMONAL DISORDERS ON ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION AND COMORBIDE ENDOCRINOPATHIES Bilovol O.M., Nemtsova V.D., Ilchenko I.A., Zlatkina V.V. Purpose: to investigate the effect of hormonal changes on endothelial dysfunction (ED) in patients with a comorbid course of hypertension (H), type 2 diabetes mellitus (T2DM) and subclinical hypothyroidism (SHT). Methods: 183 patients with  H stage II were divided into 3 groups: Group 1 (n=50) - with isolated H (comparison group); Group 2 (n=63) - with a combined course of H and T2DM; Group 3 (n=70) - with comorbidity of H, T2DM and SHT. Blood pressure levels, carbohydrate, lipid and thyroid metabolism, plasma insulin concentration, insulin resistance (IR) the HOMA-IR index, vascular endothelial growth factor (VEGF-A) plasma levels were investigated. Results: Dyslipidemia was more pronounced in group 2 than in group 1. The addition of SHT was accompanied by a tendency to increase all the atherogenic lipids. IR was observed in all patients groups and was significantly higher than in control group (p<0.05). Significant increase of VEGF-A levels in all patients groups in comparison with the control (p<0.05) was found. In group 2 VEGF-A was lower than in group 1, which is probably due to the protective effect of metformin. Analysis  of the influence of thyroid dysfunction degree on ED revealed significant increase of VEGF-A levels in TSH>6.0 μMU/ml subgroup (352.55±17.64 pg/ml vs 461.74±20.13 pg/ml (p<0.05)). Conclusion: Hormonal disorders contribute to aggravation of endothelial dysfunction in patients with hypertension and comorbid endocrinopathies - type 2 diabetes mellitus and subclinical hypothyroidism. Even minor decrease in thyroid function lead to the progression of endothelial dysfunction. Key words: hypertension, type 2 diabetes mellitus, subclinical hypothyroidism, endothelial dysfunction   Резюме. ВПЛИВ ГОРМОНАЛЬНИХ ПОРУШЕНЬ НА ЕНДОТЕЛІАЛЬНУ ДИСФУНКЦІЮ УПАЦІЄНТІВ З АРТЕРІАЛЬНОЮ ГІПЕРТЕНЗІЄЮ ТА КОМОРБІДНИМИ ЕНДОКРИНОПАТІЯМИ Біловол О.М., Немцова В.Д., Ільченко І.А., Златкіна В.В. Мета: дослідити вплив гормональних змін на ендотеліальну дисфункцію (ЕД) у пацієнтів з коморбідним перебігом артеріальної гіпертензії (АГ), цукрового діабету 2 типу (ЦД2Т) тасубклінічного гіпотиреозу (СГТ). Матеріали та методи: 183 пацієнта з АГ II стадії були розділені на 3 групи: 1-а група (n=50) - з ізольованою АГ (група порівняння); Група 2 (n=63) - з поєднаним перебігом АГ та ЦД2Т; Група 3 (n 70) – з комбінованим перебігом АГ, ЦД2Т і СГТ. Вивчали рівні артеріального тиску, показники вуглеводного, ліпідного і тиреоїдного обміну, концентрацію інсуліну в плазмі, індекс інсулінорезистентності (ІР) - HOMA-IR, рівні васкулоендотеліального фактора росту (VEGF-A) в плазмі. Результати. Ступінь дисліпідемії у 2-й групі була більш вираженою, ніж в 1-й. Приєднання СГТ супроводжувалося тенденцією до збільшення всіх атерогенних фракцій ліпідів. ІР спостерігалася у всіх групах пацієнтів і була достовірно більше, ніж у контрольній групі (р<0,05). Виявлено достовірне підвищення рівнів VEGF-A у всіх групах пацієнтів в порівнянні з контролем (р<0,05). В 2-й групі рівні VEGF-A були нижче, ніж в 1-й групі, що, ймовірно, пов'язано з протективним ефектом метформіну. Аналіз впливу ступеня гіпофункції щитовидної залози на ЕД виявив значне збільшення рівнів VEGF-A в підгрупі TSH> 6,0 мкМ / мл (352,55 ± 17,64 пг / мл і 461,74 ± 20,13 пг / мл відповідно, р <0,05). Висновки. Гормональні порушення сприяють погіршенню ендотеліальної дисфункції у пацієнтів з артеріальною гіпертензією та супутніми ендокринопатіями - цукровим діабетом 2 типу та субклінічним гіпотиреозом. Навіть незначне зниження функції щитовидної залози призводить до прогресування ендотеліальної дисфункції. Ключові слова:  гіпертензія, цукровий діабет 2 тип, субклінічний гіпотиреоз, ендотеліальна дисфункція    Резюме. ВЛИЯНИЕ ГОРМОНАЛЬНЫХ НАРУШЕНИЙ НА ЭНДОТЕЛИАЛЬНУЮ ДИСФУНКЦИЮ У ПАЦИЕНТОВ С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ И КОМОРБИДНЫМИ ЭНДОКРИНОПАТИЯМИ Беловол О.М., Немцова В.Д., Ильченко И.А., Златкина В.В. Цель: исследовать влияние гормональных изменений на эндотелиальную дисфункцию (ЭД) у пациентов с коморбидным течением артериальной гипертензии (АГ), сахарного диабета 2 типа (СД2Т) и субклинического гипотиреоза (СГТ). Материалы и методы: 183 пациента с АГ IIстадии были разделены на 3 группы: 1-я группа (n = 50) - с изолированной АГ (группа сравнения); Группа 2 (n = 63) - с сочетанным течением АГ и СД2Т; Группа 3 (n = 70) - комбинированное течение АГ, СД2Т и СГТ. Изучали уровни артериального давления,  показатели  углеводного, липидного и тиреоидного обмена, концентрацию инсулина в плазме, индекс инсулинорезистентности (ИР)- HOMA-IR, уровни васкулоэндотелиального фактора роста(VEGF-A) в плазме. Результаты. Степень дислипидемии во 2-й группе была более выраженной, чем в 1-й.  Присоединение СГТ сопровождалось тенденцией к увеличению всех атерогенных фракций липидов. ИР наблюдалась во всех группах пациентов и была достоверно больше, чем в контрольной группе (р<0,05). Выявлено достоверное повышение уровней VEGF-A во всех группах пациентов по сравнению с контролем (р <0,05). Во 2-й группе уровни VEGF-A были ниже, чем в 1-й группе, что, вероятно, связано с протективным эффектом метформина. Анализ влияния степени дисфункции щитовидной железы на ЭД выявил значительное увеличение уровней VEGF-A в подгруппе TSH> 6,0 мкМ/мл (352,55 ± 17,64 пг / мл и 461,74 ± 20,13 пг / мл соответственно, р<0,05). Заключение. Гормональные нарушения способствуют ухудшению эндотелиальной дисфункции у пациентов с артериальной гипертензией и сопутствующими эндокринопатиями - сахарным диабетом 2 типа и субклиническим гипотиреозом. Даже незначительное снижение функции щитовидной железы приводит к прогрессированию эндотелиальной дисфункции. Ключевые слова: гипертензия, сахарный диабет 2 тип, субклинический гипотиреоз, эндотелиальная дисфункция     

2019 ◽  
Vol 46 (1) ◽  
pp. 21-27
Author(s):  
A. Nikolov ◽  
A. Blazhev ◽  
M. Tzekova ◽  
K. Kostov ◽  
N. Popovski

Abstract Background and Aims: An important factor in the development of vascular wall lesions is the degradation of the elastic fiber major protein – elastin. Elastin peptides (EDP) derived from this degradation are present in the circulation and are a stimulus for the production of anti-elastin antibodies (AEAbs) IgM, IgG and IgA. The aim of this study was to investigate the possible association between AEAbs, lipid indices and the development of microvascular complications. Material and Methods: Sera of 93 patients with type 2 diabetes mellitus (T2DM) and arterial hypertension (AH) were investigated (mean age 61,4 ± 11,3 years, diabetes duration 9,88 ± 3,12 years; hypertension duration 9,28 ± 4,98). ELISA was used for determination of anti-elastin antibodies. These levels were compared to serum AEAbs in 42 age- and sex-matched controls. Diabetic patients were divided in two groups according to the presence – Group 1 (n = 67) or absence – Group 2 (n = 26) of microangiopathy. The lipid profile and lipid indices (log TG/HDL, LDL/HDL, TC/HDL and TG/HDL) were also studied. Results: Patients with T2DM and AH showed statistically significant higher levels of serum AEAbs IgA than healthy controls – 0,338 (0,133÷0,452) vs. 0,006 (0,052÷0,068) (KW = 19,54; P < 0.0001). Group 1 showed statistically significant higher levels of AEAbs IgA than patients without microangiopathy – 0,353 (0,173÷0,471) vs. 0,235 (0,098÷0,377) (KW = 3,36; p = 0.05) and healthy controls – 0,353 (0,173÷0,471) vs. 0,006 (0,052÷0,068) (KW = 20,37; p < 0,0001) (0.37 ± 0,03 vs. 0.06÷0.01) (p = 0.0001). Patients from Group 2 showed significantly higher levels of AEAbs IgA than controls 0,235 (0,098÷0,377) vs. 0,006 (0,052÷0,068) (KW = 8,54; P = 0.003). AEAbs IgA showed correlation with insulin dose (r = −0.35); (p = 0.01), SBP (r = 0.31); (p = 0.001), HbA1c (r = 0.21); (p = 0.04), BMI (r = 0.22); (p = 0.01). AEAbs IgA correlated with log TG/HDL (r = 0.28); (p = 0.001), LDL/HDL (r = 0.22); (p = 0.01) TC/HDL (r = 0.22); (p = 0.01) and with TG/HDL (r = 0.15); (p = 0.05). Conclusion: Our study proved a relationship between elevation of AEAb IgA, high lipid indices and the development of microvascular complications in patients with type 2 diabetes mellitus and arterial hypertension.


Author(s):  
М.А. Быковская ◽  
А.А. Раскуражев ◽  
А.А. Шабалина ◽  
К.В. Антонова ◽  
М.М. Танашян

Введение. Сосудистые осложнения сахарного диабета (СД) являются одной из ведущих причин повышения смертности пациентов трудоспособного возраста. Предполагается, что индуцированный гипергликемией окислительный стресс и нарушение антиоксидантной защиты играют роль в патологическом механизме повреждения сосудов, частично за счет влияния оксида азота (NО). Цель исследования: уточнение взаимосвязей в системах асимметричного диметиларгинина (АДМА) и NO у пациентов с цереброваскулярными заболеваниями (ЦВЗ) на фоне СД 2-го типа (СД-2). Материалы и методы. Обследованы 72 пациента с ЦВЗ со стенозирующим поражением внутренней сонной артерии вне острого периода: группу 1 составили 39 пациентов (18 мужчин и 21 женщина) с СД-2 в возрасте 65 [58; 72] лет; в группу 2 вошли 33 больных (15 мужчин и 18 женщин) без СД-2 в возрасте 66 [56; 74] лет. Контрольную группу составили 30 добровольцев (16 мужчин и 14 женщин) без проявлений церебральной ишемии и нарушений углеводного обмена, с нормальными значениями индекса массы тела, некурящие, в возрасте 62 [50; 66] лет. Проводилось клиническое обследование, нейро- и ангиовизуализационное исследование, спектр биохимических исследований крови, в том числе определение содержания АДМА и показателей системы NO. Результаты. В группе 1 содержание нитрата, нитрита и NO составило 62,1 [56; 68] мкмоль/л, 48,5 [26; 52] мкмоль/л и 13,6 [9; 23] мкмоль/л соответственно, что достоверно отличалось от значений этих показателей в группе 2 — 58,3 [45; 64] мкмоль/л, 39,6 [26,0; 42,3] мкмоль/л и 18,7 [16,1; 24,7] мкмоль/л соответственно. Отмечен также более высокий уровень AДМА в крови у пациентов с ЦВЗ в сочетании с СД-2 — 0,42 [0,21; 0,53] ммоль/л. Заключение. Обнаружена взаимосвязь между уровнями AДМА и NO при ЦВЗ на фоне СД-2. Это требует продолжения исследований биомаркеров повреждения сосудистой стенки для определения их места в патогенезе ишемических церебральных осложнений СД-2. Background. Vascular complications of diabetes mellitus (DM) are one of the leading causes of increased mortality in patients of employable age. Hyperglycemia-induced oxidative stress and impaired antioxidant protection have been suggested to play a role in the pathological mechanism of vascular damage, in part due to the effects of nitric oxide (NO). Objectives: clarification of relationships in the systems of asymmetric dimethylarginine (ADMA) and NO in patients with cerebrovascular diseases (CVD) and type 2 diabetes (DM-2). Patients/Methods. We examined 72 CVD patients with stenosing lesions of the internal carotid artery outside the acute period: group 1 consisted of 39 patients (18 men and 21 women; 65 [58; 72] years old) with DM-2; group 2 consisted of 33 patients (15 men and 18 women; 66 [56; 74] years old) without DM-2. The control group consisted of 30 volunteers (16 men and 14 women; 62 [50; 66] years old) without manifestations of cerebral ischemia and carbohydrate metabolism disorders, with normal body mass index, non-smokers. A clinical examination, neuro- and angio-imaging study, a spectrum of biochemical blood tests, including the concentration of asymmetric dimethylarginine (ADMA) and indicators of NO system were carried out. Results. In group 1, the content of nitrate, nitrite and NO was 62.1 [56; 68] μmol/l, 48.5 [26; 52] μmol/l and 13.6 [9; 23] μmol/l, respectively, that significantly differed from the content of these parameters in group 2 — 58.3 [45; 64] μmol/l, 39.6 [26.0; 42.3] μmol/l and 18.7 [16.1; 24.7] μmol/l, respectively. Noted also a higher blood level of ADMA in patients with CVD combined with DM-2 — 0.42 [0.21; 0.53] mmol/l. Conclusions. A relationship was found between ADMA and NO levels in CVD patients with DM-2. This requires further studies of biomarkers of vascular wall damage to determine their place in the pathogenesis of ischemic cerebral complications of DM-2.


2022 ◽  
Vol 24 (5) ◽  
pp. 448-455
Author(s):  
A. Yu. Tokmakova ◽  
E. A. Kogan ◽  
E. L. Zaitseva ◽  
S. A. Demura ◽  
N. V. Zharkov ◽  
...  

Background: Diabetic neuroosteoarthropathy is a serious disabling complication of diabetes mellitus, which, in the absence of timely correct treatment, can lead to high amputations of the affected limb. At present, the reasons and mechanism of the development of Charcot’s foot are not completely clear. It is extremely important to determine the pathophysiological mechanisms of DNOAP formation and to search for reliable markers-predictors of this pathology.Aim: To study the immunohistochemical characteristics of the bone tissue of the lower extremities in patients with diabetic neuroosteoarthropathy in comparison with patients with diabetes mellitus without this pathology.Materials and methods: During the foot surgery, a bone fragment of the foot was harvested for immunohistochemical study of receptor markers for PINP, PIIINP, and RAGE in the group of patients with DNOAP compared with the control group.Results: The study included 20 patients with type 2 diabetes mellitus and were divided into 2 groups: 10 patients with DNOAP made up group 1, 10 patients without DNOAP — group 2.Patients in both groups were comparable in AGE, experience with type 2 diabetes, and glycemic control.During the immunohistochemical study, a significant increase in the staining intensity of receptor markers for PINP, PIIINP, and AGE was recorded in the group of patients with DNOAP compared with the control group (p <0.05).Conclusion: For the first time, an immunohistochemical study of markers of bone resorption and AGE was carried out in persons with DNOAP. The results obtained indicate impaired collagen formation and, as a consequence, impaired bone formation and bone resorption in patients with DNOAP: in group 1, a statistically significant increase in the expression of PINP, PIIINP, and RAGE was revealed.


2020 ◽  
Vol 1 (1) ◽  
pp. 17-22
Author(s):  
C K Akshaya ◽  

ABO and Rh blood group systems have been associated with a number of diseases including type-2 diabetes mellitus (T2DM). Epidemiological studies have inconsistently associated ABO and Rhesus (Rh) blood groups with T2DM risk. To assess the distribution of ABO and Rh blood groups among type-2 diabetic subjects and to check the potential association between ABO and Rh blood groups with T2DM. This small retrospective case-control study was conducted at DM WIMS Hospital, Wayanad. One-year data (from Jan-18 to Jan-19) of fasting, postprandial or random plasma/serum glucose, HbA1c, ABO and Rh blood groups of Non- diabetic and type -2 diabetic subjects were collected from the Hospital Clinical Laboratory Medicine department. Among 280 randomly selected data, 147 are non-diabetic subjects, and 133 are confirmed and known cases of type 2 diabetic mellitus. Subjects with Blood group B has the highest distribution percentage among group-2 (59.39%) in comparison with group-1 (34.02%), followed by A (19.55%), O (18.79%), AB (2.27%). Statistical analysis using Chi-square test among ABO and Rh blood groups between group-1 and group-2 showed a significant (p< 0.001) association of blood group “B +ve” and least association of blood group “O +ve” with T2DM. However, the Rh Blood groups evaluation for T2DM showed no clear association, as both Rh +ve and Rh -ve were uniformly distributed in the groups. The ABO and Rh blood groups may have a possible role to play in the development of T2DM. The subjects with B + ve blood group are at greater risk for T2DM and O + ve blood group individuals are at lower risk for T2DM. Keywords: Blood groups; ABO blood groups; Rh blood groups; Type 2 Diabetes Mellitus; distribution; association REFERENCES


2021 ◽  
Vol 9 (1) ◽  
pp. 21-27
Author(s):  
S.O. Rykov ◽  
K.V. Korobov ◽  
S.Yu. Mogilevskyy

Background. One of the early microvascular complications of type 2 diabetes mellitus (T2DM) is diabetic retino­pathy (DR). Its main cause is prolonged hyperglycemia, which triggers the development of microangiopathy. In this regard, the issue of damage to paired eyes and the spread of DR in the initial stages has not been fully clarified. The purpose: to study the peculiarities of lesions of paired eyes at the initial stages of non-proliferative diabetic retinopathy in patients with type 2 dia­betes mellitus. Materials and methods. We examined 91 patients with T2DM (182 eyes), who did not have retinopathy according to the International Diabetic Retinopathy Severity Scale of the American Academy of Ophthalmology (2002). Paired eyes were divided into three groups: group 1 included 132 paired eyes (66 patients) with 10 points according to the Early Treatment Diabetic Retinopathy Group Study (ETDRS); group 2 consisted of 25 eyes with 10 points on ETDRS, and group 3 — 25 paired eyes with retinal vascular anomalies (14–15 points on ETDRS). The patients were examined again after 1 year. According to the ETDRS, Airlie House classification, microaneurysms, microhemorrhages, intraretinal microvascular abnormalities, retinal vascular abnormalities, and retinal nonperfusion were detec­ted. Results. The majority (58.3 %) of paired eyes without initial changes (group 1) had no progression of DR within 1 year, 12.9 % had vascular anomalies (14–15 points on ETDRS), 13.6 % deve­loped mild, and 15.2 % — moderate non-proliferative DR. The highest progression of DR (88.0 % of eyes) was observed in eyes without diabetic vascular changes, which were paired to eyes with such changes (group 2) that was 2.1 times (p < 0.001) higher than the indicator of paired eyes without diabetic changes (group 1; 41.7 %). Most eyes that had mild vascular changes (group 3) progressed to moderate non-proliferative DR after 1 year, which was four times more often than in eyes that had no initial changes (60.0 versus 15.2 %; p < 0.001). DR in the eyes of group 3 with progression accounted for 43–47 points on EDTRS; the visual acuity of these eyes, both before and after 1 year, was significantly lower than in other groups, and the level of glycated hemoglobin in the blood of patients with such eyes was significantly higher. Conclusions. This study established the features of the progression of early stages of DR in patients with T2DM, and the significance of primary retinal vascular anomalies in the presence of which the progression of DR was faster.


2021 ◽  
Vol 17 (1) ◽  
pp. 1-8
Author(s):  
Serhat Özçelik ◽  
Mehmet Çelik ◽  
Aşkı Vural ◽  
Bünyamin Aydın ◽  
Melike Özçelik ◽  
...  

IntroductionTo evaluate the efficacy and safety of transition from premixed and intensive insulin to twice-daily insulin degludec/aspart (IDegAsp) co-formulation in patients with type 2 diabetes mellitus.Material and methodsIn this 12-week study, patients receiving twice-daily premixed insulin therapy in group 1 (n = 55) were switched to twice-daily IDegAsp. In group 2 (n = 60), patients on intensive insulin therapy were switched to IDegAsp injected twice a day. Inter- and intragroup comparisons were made.ResultsA total of 115 patients were included in the study. There was a significant improvement in glycaemic control, median daily total insulin dose, body mass, body mass index, and hypoglycaemic events in group 1 and group 2 with the switch to IDegAsp (p < 0.05). The decrease in median daily total insulin dose requirement in group 2 was higher than that of group 1 (p = 0.001). There was no difference between groups in terms of other parameters (p > 0.05).ConclusionsThe current analysis indicates that IDegAsp treatment improves outcomes, with the most notable differences observed in daily total insulin requirement, body mass, and hypoglycaemia.


2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092606
Author(s):  
Maria Isabel del Olmo-García ◽  
David Hervás Marín ◽  
Jana Caudet Esteban ◽  
Antonio Ballesteros Martin-Portugués ◽  
Alba Cerveró Rubio ◽  
...  

Objective To explore the glucagon-like peptide-1 analogue liraglutide in the hospital setting in patients with type 2 diabetes mellitus (T2DM) and acute coronary syndrome and to evaluate the safety and efficacy and its impact on hospitalization and short-term glycemic variability (GV). Methods A 12-week, open-label, prospective, randomized pilot clinical study with parallel groups that compared liraglutide (group 1) with glargine (group 2) and its impact on glycemic control and GV. Results Thirteen patients were included. During hospitalization, mean glucose was 164.75 mg/dL (standard deviation [SD] 19.94) in group 1 and 166.69 mg/dL (38.22) in group 2. GV determined by CV and SD was 20.98 (7.68) vs. 25.48 (7.19) and 34.37 (13.05) vs. 43.56 (19.53) in groups 1 and 2, respectively. Group 1 prandial insulin requirements during hospitalization were lower compared with group 2. Follow-up A1c in group 1 was 6.9% (−1.51%) and 6.5% in group 2 (−1.27). GV after discharge and hypoglycemia were lower in group 1 compared with group 2. Conclusions Liraglutide seems to reduce GV in the acute phase of acute coronary syndrome, and patients achieved optimal control with a low incidence of hypoglycemia. These results support the need to explore liraglutide in a larger multicenter trial. Trial registration: The study was approved by the National Medical Ethics Committee of Spain. The study was registered at European Clinical Trials Database (EudraCT): 2014003298-40.


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