Značaj pulsatilnog indeksa za procenu hemodinamskih promena u perifernoj arterijskoj cirkulaciji gojaznih osoba lečenih orlistatom
Sažetak
Uvod/Cilj. Dugotrajna hiperinsulinemija ubrzava proces endotelne disfunkcije i nastajanja arteriosklerotskih promena što utiče na nastanak kardiovaskularnih i cerebrovaskularnih oboljenja. Za procenu ranih funkcinalnih promena u arterijskom zidu danas postoje različite metode merenja kao što su protokom posredovana endotel zavisna vazodilatacija-FMD(flow mediated vasodilatation), analiza pulsnog talasa, procena debljine intime i medije /FMD/, venska pletizmografija...svaka sa određenim ograničenjima u tumačenju rezultata. Cilj našeg rada je bio da ukazemo na povezanost pulzatilnog indeksa /PI/-koji pokazuje kontraktilnost perifernih arerija, sa izmenjenim metaboličkim parametrima u uslovima insulinske rezistencije. Metod. Ispitivanjem je bilo obuhvaćeno 35 zdravih gojaznih osoba, sa vrednostima BMI iznad 3o kg/m2, koji su po metodi duplo slepog dizajna bili randomizovani u dve grupe-placebo i orlistat. Na osnovu vrednosti glikemija i insulinemija, primenom formule bio je izračunat nivo insulinske senzitivnosti (ISI). Rezultati. Naši rezultati pokazuju da je, u orlistat (p<0,002) grupi, došlo do statistički značajnog poboljšanja PI, dok u placebo grupi nije bilo signifikantnog uvećanja PI. Zaključak. Dobijeni rezultati ukazuju, da je poboljšanje insulinske senzitivnosti, u fazi rane ateroskleroze, značajan faktor povoljnih uticaja na perifernu arterijsku cirkulaciju, čemu dodatno doprinosi redukcija nivoa lipidnih frakcija, posebno triglicerida. Prve hemodinamske promene, u uslovima smanjene insulinske rezistencije, karakteriše porast kontraktilnosti arterijskog zida, procenjeno odredjivanjem PI.
Reference
Campbell P, Gerish J. Impact of obesity on insulin action in volunteers with normal glucose tolerance: demonstration of a threshold for the adverse effect of obesity. J Clin Endocrinol Metab 1990; 70(4): 1114‒8.
Bougneres PF, Artavia-Loria P, Henry S, Basdevant A, Castaño L. Increased basal glucose production and utilisation in children with recent obesity versus adults with long-term obesity. Dia-betes 1989; 38(4): 477‒83.
Lillioja S, Bogardus C. Obesity and insulin resistance: lessons learned from Pima Indians. Diabetes Metab Rev 1988; 4(4): 517‒40.
Laakso M, Edelman SV, Brechtel G, Baron AD. Decreases effect of insulin stimulate sceletal blood flow in obese man. A novel mechanism for insulin resistance. J Clin Invest 1990; 85(6): 1844‒52.
Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesi-ty to insulin resistance and type 2 diabetes. Nature 2006; 444(7121): 840–6.
Schmidt AM, Stern DM. Hyperinsulinemia and vascular dys-function: the role of nuclear factor-kappa B, yet again. Circ Res 2000; 87(9): 722‒4.
Anderson TJ, Uehata A, Gerhard MD, Meredith IT, Knab S, Delagrande D, et al. Close ralation of endothelial function in the human coronary and peripheral circulations. J Am Coll Cardiol 1995; 26(5): 1235‒41.
Stühlinger MC, Abbasi F, Chu JW, Lamendola C, McLaughlin TL, Cooke JP, et al. Relationship between insulin resistance and an endogenous nitric oxide synthase inhibitor. JAMA 2002; 287(11): 1420‒6.
Böhm F, Ahlborg G, Pernow J. Endothelin-1 inhibits endotheli-um-dependent vasodilatation in the human forearm: reversal by ETA receptor blockade in patients with atherosclerosis. Clin Sci (Lond) 2002; 102(3): 321‒7.
Cardillo C, Nambi SS, Kilcoyne CM, Choucair WK, Katz A, Quon MJ, et al. Insulin stimulates both endothelin and nitric oxide activity in the human forearm. Circulation 1999; 100(8): 820‒5.
Pearson JD. Normal endothelial cell function. Lupus 2000; 9(3): 183‒8.
Laroia ST, Ganti AK, Laroia AT, Tendulkar KK. Endothelium and the lipid metabolism: the current understanding. Int J Cardiol 2003; 88(1): 1‒9.
Cardillo C, Kilcoyne CM, Cannon RO 3rd, Panza JA. Interactions between nitric oxide and endothelin in the regulation of vas-cular tone of human resistance vessels in vivo. Hypertension 2000; 35(6): 1237‒41.
Daiber A, Steven S, Weber A, Shuvaev VV, Muzykantov VR, La-her I, et al. Targeting vascular (endothelial) dysfunction. Br J Pharmacol 2017; 174(12): 1591‒619.
Su JB. Vascular endothelial dysfunction and pharmacological treatment. World J Cardiol 2015; 7(11): 719‒41.
Hristova K. The Role of Noninvasive Imaging for Detection High Risk Patients with Subclinical Atherosclerosis. Arch Clin Hypertens 2016; 1(1): 004‒012.
Sitia S, Tomasoni L, Atzeni F, Ambrosio G, Cordiano C, Catapano A, et al. From endothelial dysfunction to atherosclerosis. Au-toimmun Rev 2010; 9(12): 830–4.
Jacotot B, Castaigne A. Coronary atherosclerosis. In: Jacotot B, editor. Coronary Artery Disease. Lonodon: PIL; 1996. (French)
Vallance P, Collier J, Moncada S. Effects of endothelium-derived nitric oxide on peripheral arteriolar tone in man. Lan-cet 1989; 2(8670): 997‒1000.
Zdravković M. Atherosclerosis – development and consequenc-es. In: Kažić T, Zdravković M, editors. Clinical Cardiovascular Pharmacology. Beograd: Integra; 1997. p. 123‒42. (Serbian)
Tooke J. The association between insulin resistance and endo-theliopathy. Diabetes Obes Metab 1999; 1(Suppl 1): 17‒22.
Schiffrin EL. Canadian Institutes of Health Research Multidis-ciplinary Research Group on Hypertension. Beyond blood pressure: the endothelium and atherosclerosis progression. Am J Hypertens 2002; 15(10 Pt 2): 115S‒22S.
Shichiri M, Yokokura M, Marumo F, Hirata Y. Endothelin-1 in-hibits apoptosis of vascular smooth muscle cells induced by ni-tric oxide and serum deprivation via MAP kinase pathway. Arterioscler Thromb Vasc Biol 2000; 20(4): 989‒97.
Bressler P, Bailey SR, Matsuda M, DeFronzo RA. Insulin re-sistance and coronary artery disease. Diabetologia 1996; 39(11): 1345‒50.
Fuster V, Ross R, Topol EJ. Atherosclerosis and coronary artery disease. New York, NY: Lippincott-Raven; 1996. p. 387‒99.
Healy B. Endothelial cell dysfunction: an emerging endocrino-pathy linked to coronary disease. J Am Coll Cardiol 1990; 16(2): 357‒8.
Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 1993; 362(6423): 801‒9.
Corretti MC, Plotnick GD, Vogel RA. Technical aspects of eval-uating brachial artery vasodilatation using high-frequency ul-trasound. Am J Physiol 1995; 268(4 Pt 2): 1397‒404.
Li J, Zhao SP, Li XP, Zhuo QC, Gao M, Lu SK. Non-invasive detection of endothelial dysfunction in patients with essential hypertension. Int J Cardiol 1997; 61(2): 165‒9.
Clarkson P, Celermajer DS, Powe AJ, Donald AE, Henry RMA, Deanfield JE. Endothelium-dependent dilatation is impaired in young healthy subjects with a family history of premature cor-onary disease. Circulation 1997; 96(10): 3378–83.
Patil P, Shejol S, Pathak KP. Assessment endothelial dysfunction in essential hypertension duration of 2 years by ultrasonogra-phy. Indian J Appl Res 2015; 5(11): doi 10.15373/2249-555X.
Kozakova M, Palombo C. Vascular Ultrasound and Cardiovascu-lar Risk Assessment. Austin J Vasc Med 2016; 3(1): 1015.
Qu B, Qu T. Causes of changes in carotid intima-media thick-ness: a literature review. Cardiovasc Ultrasound 2015; 13: 46.
Bernstein E. Non-invasive diagnosis in vascular disease. St. Louis: CV Mosby Co; 1986.
Zierler RE, Dawson DL. Strandness's Duplex Scanning in Vas-cular Disorders. New York: Raven Press; 2015.
Carter S, Tate RB. Value of toe pulse waves in addition to sys-tolic pressures in the assessment of the severity of peripheral arterial disease and critical limb ischemia. J Vasc Surg 1996; 24(2): 258‒65.
Howard G, O'Leary DH, Zaccaro D, Haffner S, Rewers M, Ham-man R, et al. Insulin sensitivity and atherosclerosis. The Insulin Resistance Atherosclerosis Study (IRAS) Investigators. Circu-lation 1996; 93(10): 1809‒17.
Allan PL, Mowbray PI, Lee AJ, Fowkes FG. Relationship be-tween carotid intima-media thickness and symptomatic and asymptomatic peripheral arterial disease. The Edinburgh Ar-tery Study. Stroke 1997; 28(2): 348‒53.
Bokemark L, Wikstrand J, Attvall S, Hulthe J, Wedel H, Fagerberg B. Insulin resistance and intima-media thickness in the carotid and femoral arteries of clinically healthy 58-year-old men. The Atherosclerosis and Insulin Resistance Study (AIR). J Intern Med 2001; 249(1): 59‒67.
Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucosetolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 1999; 22(9): 1462‒70.
Wingard DL, Barrett-Connor E. Family history of diabetes and cardiovascular disease risk factors and mortality among euglycemic, borderline hyperglycemic,and diabetic adults. Am J Epidemiol 1987; 125(6): 948‒58.
Rewers M, Shetterly SM, Baxter J, Marshall JA, Hamman RF. Prevalence of coronary heart disease in subjects with normal and impaired glucose tolerance and non-insulin-dependent di-abetes mellitus in a biethnic Colorado population. The San Luis Valley Diabetes Study. Am J Epidemiol 1992; 135(12): 1321‒30.
Mykkänen L, Laakso M, Pyörälä K. Asymptomatic hyperemia and atherosclerotic vascular disease in the elderly. Diabetes Care 1992; 15(8): 1020‒30.
Yamasaki Y, Kawamori R, Matsushima H, Nishizawa H, Kodama M, Kubota M, et al. Asymptomatic hyperglycaemia is associated with increased intimal plus medial thickness of the carotid ar-tery. Diabetologia 1995; 38(5): 585‒91.
Avogaro A, Albiero M, Menegazzo L, de Kreutzenberg S, Fadini GP. Endothelial dysfunction in diabetes: the role of reparatory mechanisms. Diabetes Care 2011; 34 Suppl 2: S285‒90.
Carlos TM, Harlan JM. Leukocyte-endothelial adhesion mole-cules. Blood 1994; 84(7): 2068‒101.
Sena CM, Pereira AM, Seiça R. Endothelial dysfunction - a ma-jor mediator of diabetic vascular disease. Biochim Biophys Ac-ta 2013; 1832(12): 2216‒31.
Benetos A, Safar M, Rudnichi A, Smulyan H, Richard JL, Duci-metieère P, et al. Pulse pressure: a predictor of long-term cardi-ovascular mortality in a French male population. Hyperten-sion 1997; 30(6): 1410‒5.
Hirai T, Sasayama S, Kawasaki T, Yagi S. Stiffness of systemic arteries in patients with myocardial infarction. A noninvasive method to predict severity of coronary atherosclerosis. Circu-lation 1989; 80(1): 78‒86.
O'Rourke MF, Staessen JA, Vlachopoulos C, Duprez D, Plante GE. Clinical applications of arterial stiffness; definitions and reference values. Am J Hypertens 2002; 15(5): 426‒44.
Greenwald SE. Pulse pressure and arterial elasticity. QJM 2002; 95(2): 107‒12.
Van Bortel LM, Struijker-Boudier HA, Safar ME. Pulse pres-sure, arterial stiffness, and drug treatment of hypertension. Hypertension 2001; 38(4): 914-21.
O'Rourke MF, Mancia G. Arterial stiffness. J Hypertens 1999; 17(1): 1‒4.
Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardi-ovascular diseases. Circulation 2003; 107(22): 2864‒9.
Klemsdal TO, Andersson TL, Matz J, Ferns GA, Gjesdal K, Anggård EE. Vitamin E restores endothelium dependent vaso-dilatation in cholesterol fed rabbits: in vivo measurements by photoplethysmography. Cardiovasc Res 1994; 28(9): 1397‒402.
Chowienczyk PJ, Kelly RP, MacCallum H, Millasseau SC, Anders-son TL, Gosling RG, et al. Photoplethysmographic assessment of pulse wave reflection: blunted response to endothelium-dependent beta2-adrenergic vasodilation in type II diabetes mellitus. J Am Coll Cardiol 1999; 34(7): 2007‒14.
Shinozaki K, Kashiwagi A, Nishio Y, Okamura T, Yoshida Y, Ma-sada M, et al. Abnormal biopterin metabolism is a major cause of impaired endothelium-dependent relaxation through nitric oxide/O2- imbalance in insulin-resistant rat aorta. Diabetes 1999; 48(12): 2437‒45.
Zhang H, Dellsperger KC, Zhang C. The link between metabolic abnormalities and endothelial dysfunction in type 2 diabetes: an update. Basic Res Cardiol 2012; 107(1): 237.
Domingueti CP, Dusse LM, Carvalho Md, de Sousa LP, Gomes KB, Fernandes AP. Diabetes mellitus: The linkage between ox-idative stress, inflammation, hypercoagulability and vascular complications. J Diabetes Complications 2016; 30(4): 738‒45.
Reaven GM, Lithell H, Landsberg L. Hypertension and associat-ed metabolic abnormalities--the role of insulin resistance and the sympathoadrenal system. N Engl J Med 1996; 334(6): 374‒81.
Reaven G, Segal K, Hauptman J, Boldrin M, Lucas C. Effect of orlistat-assisted weight loss in decreasing coronary heart dis-ease risk in patients with syndrome X. Am J Cardiol 2001; 87(7): 827‒31.