diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12915diaendo-12915Research ArticleОригинальные исследованияOriginal StudiesСочетанное атеросклеротическое поражение сонных артерий и артерий нижних конечностей у больных сахарным диабетом 2 типа: факторы риска и биомаркерыAssociation of carotid atherosclerosis and peripheral artery disease in patients with type 2 diabetes: risk factors and biomarkershttps://orcid.org/0000-0002-8629-7030КоролеваЕ. А.KorolevaE. A.

Королева Елена Анатольевна - кандидат медицинских наук, старший научный струдник ; Scopus Author ID: 55522435000.

Новосибирск

Elena A. Koroleva - MD, PhD, senior research associate. ; Scopus Author ID: 55522435000

Novosibirsk

ekoro@bk.ruhttps://orcid.org/0000-0001-6861-7152ХапаевР. С.KhapaevR. S.

Хапаев Рустам Сагитович - кандидат медицинских наук, старший научный струдник

Новосибирск

Rustam S. Khapaev - MD, PhD, senior research associate.

Novosibirsk

rskhapaev@outlook.comhttps://orcid.org/0000-0003-4897-8676ЛыковА. П.LykovA. P.

Лыков Александр Петрович, кандидат медицинских наук, ведущий научный струдник; Scopus Author ID: 7005078523

Новосибирск

Alexander P. Lykov - MD, PhD, leading research associate; Scopus Author ID: 7005078523.

Novosibirsk

aplykov2@mail.ruhttps://orcid.org/0000-0003-3502-5892КорбутА. И.KorbutA. I.

Корбут Антон Иванович - кандидат медицинских наук, старший научный струдник; Scopus Author ID: 57151138800.

Новосибирск

Anton I. Korbut - MD, PhD, senior research associate; Scopus Author ID: 57151138800

Novosibirsk

anton.korbut@gmail.comhttps://orcid.org/0000-0002-5407-8722КлимонтовВ. В.KlimontovV. V.

Климонтов Вадим Валерьевич - доктор медицинских наук, профессор; Researcher ID: R-7689-2017; Scopus Author ID: 8295977000.

630060, Новосибирск, ул. Тимакова, д. 2

Vadim V. Klimontov - MD, PhD, Professor; Researcher ID: R-7689-2017; Scopus Author ID: 8295977000

2 Timakov street, 630060 Novosibirsk

klimontov@mail.ruНаучно-исследовательский институт клинической и экспериментальной лимфологии — филиал ФГБНУ Федеральный исследовательский центр Институт цитологии и генетики Сибирского отделения Российской академии наукРоссияResearch Institute of Clinical and Experimental Lymphology — Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (RICEL — Branch of IC&G SB RAS)Russian Federation202315052023262172181Copyright © Королева Е.А., Хапаев Р.С., Лыков А.П., Корбут А.И., Климонтов В.В., 20232023Королева Е.А., Хапаев Р.С., Лыков А.П., Корбут А.И., Климонтов В.В.Koroleva E.A., Khapaev R.S., Lykov A.P., Korbut A.I., Klimontov V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/12915ОБОСНОВАНИЕ

ОБОСНОВАНИЕ. Атеросклероз сонных артерий (СА) и артерий нижних конечностей (АНК) — распространенные и потенциально жизнеугрожающие коморбидные состояния при сахарном диабете (СД).

ЦЕЛЬ

ЦЕЛЬ. Определить факторы риска и биомаркеры сочетанного атеросклеротического поражения СА и АНК у больных СД 2 типа (СД2).

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ. Проведено одноцентровое поперечное сравнительное исследование. В исследование включен 391 больной. Всем пациентам выполнены ультразвуковое дуплексное сканирование СА и АНК, скрининг/мониторинг осложнений диабета и ассоциированных состояний, исследованы параметры гликемического контроля, биохимические параметры, показатели гемостаза. В сыворотке крови с помощью иммуноферментного анализа определяли факторы, вовлеченные в ремоделирование сосудистой стенки: кальпонин-1, релаксин, L-цитруллин, матриксные металлопротеиназы-2 и -3.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Признаки атеросклероза СА и АНК выявлены у 330 и 187 больных соответственно. У 178 пациентов выявлено сочетание атеросклероза СА и АНК. Риск сочетанного поражения СА и АНК был выше у больных с диабетической ретинопатией (ОШ=2,57; р<0,001), хронической болезнью почек (ОШ=4,48; р<0,001), инфарктом миокарда (ОШ=5,09; р<0,001), коронарной реваскуляризацией (ОШ=4,31; р<0,001) или острым нарушением мозгового кровообращения (ОШ=3,07; р<0,001) в анамнезе. В ROC-анализе факторами риска сочетанного атеросклероза СА и АНК являлись: возраст ≥65,5 года (ОШ=3,43; р<0,001), соотношение окружность талии/окружность бедер (ОТ/ОБ) ≥0,967 (ОШ=3,01; р=0,001), длительность СД ≥12,5 года (ОШ=3,7; р<0,001), длительность инсулинотерапии ≥4,5 года (ОШ=3,05; р<0,001), длительность артериальной гипертензии ≥16,5 года (ОШ=1,98; р=0,002), уровень L-цитруллина сыворотки ≥68 мкмоль/л (ОШ=3,82; р=0,003), средняя амплитуда колебаний гликемии (MAGE) ≥3,72 ммоль/л (ОШ=1,79; р=0,006). В многофакторном логистическом регрессионном анализе независимыми факторами риска атеросклероза СА и АНК были возраст (р=0,005), длительность СД (р=0,0003) и ОТ/ОБ (р=0,004).

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. Сочетанное поражение СА и АНК у больных СД2 ассоциировано с возрастом, длительностью СД, абдоминальным ожирением, микрососудистыми и макрососудистыми осложнениями, вариабельностью гликемии, высоким уровнем L-цитруллина.

BACKGROUND

BACKGROUND: Carotid atherosclerosis (CA) and lower extremity peripheral artery disease (PAD) is a common and potentially life-threatening comorbidity in diabetes.

AIM

AIM: to determine risk factors and biomarkers of the association of CA and PAD in patients with type 2 diabetes.

MATERIALS AND METHODS

MATERIALS AND METHODS: A single-center cross-sectional comparative study was carried out. Three hundred ninety one patients with type 2 diabetes were included. Duplex ultrasound of carotid and low limb arteries, screening/monitoring of diabetic complications and associated diseases, and assessment of glycemic control, biochemical and coagulation parameters were performed. Factors involved in vascular wall remodeling, including calponin-1, relaxin, L-citrulline, matrix metalloproteinase-2 and -3, were measured in blood serum by ELISA.

RESULTS

RESULTS: The signs of CA and PAD were observed in 330 and 187 patients respectively. In 178 patients, both CA and PAD were revealed. The risk of combined involvement of carotid and lower extremity arteries was higher in patients with diabetic retinopathy (OR=2.57, p<0.001), chronic kidney disease (OR=4.48, p<0.001), history of myocardial infarction (OR=5.09, p<0.001), coronary revascularization (OR=4.31, p<0.001) or cerebrovascular accident (OR=3.07, p<0.001). In ROC-analysis, age ≥65.5 years (OR=3.43, p<0.001), waist-to-hip ratio ≥0.967 (OR=3.01, p=0.001), diabetes duration ≥12.5 years (OR=3.7, p<0.001), duration of insulin therapy ≥4.5 years (OR=3.05, p<0.001), duration of arterial hypertension ≥16.5 years (OR=1.98, p=0.002), serum L-citrulline ≥68 µmol/l (OR=3.82, p=0.003), and mean amplitude of glucose excursions ≥3.72 mmol/l (OR=1.79, p=0.006) were the risk factors for atherosclerosis of two vascular beds. In multivariate logistic regression analysis, age, diabetes duration and waist-to-hip ratio were independent risk factors for association of CA and PAD (p=0.005, p=0.0003, and p=0.004 respectively).

CONCLUSION

CONCLUSION: In subjects with type 2 diabetes, carotid and lower extremity atherosclerotic disease is associated with age, diabetes duration, abdominal obesity, microvascular and macrovascular complications, glucose variability, and high serum levels of L-citrulline.

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The authors declare that there are no conflicts of interest present.