EUROMEDICA  Hanover 6-7  Juni 2008	Advanced methods of diagnosis, treatment and prophylactics
	European Academy of Natural Sciences, Hanover European Scientific Society, Hanover Russian Academy of Natural Sciences, Moscow

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Endothelial dysfunction and proteinuria are associated with higher risk of stroke in patients with arterial hypertension (AH) and diabetes mellitus (DM) and can be caused by general vascular pathology leading to glomerular disruption and development of early structural changes in the brain.

Objective: to define possible relationship between endothelial dysfunction and microalbuminuria with early cerebrovascular changes in patients with combined AH and DM type 2.

Methods: 51 patients with combined AH and DM type 2 (10 males, 40-61) were enrolled in to the study. All patients underwent brain MRI, ultrasound scan (Acuson 128XP 10, USA) to do a flow mediated dilation (FMD) of brachial artery, laboratory analysis of the level of Willibrand factor (vWF) (Biola agregometer, LA 230), microalbuminuria (MAU) (immunoturbometic method with the use of semiautomatic FP-900, and standard kits for microalbuminuria assay “RANDOX”)

Results: according to correlation analysis, there was relationship between the number of regions with focal white matter lesions (FWML) and FMD and endothelial sensitivity to the share stress (r=-0,45, p=0,017 and r=-0,47, p=0,017, accordingly), and with the level of vWF (r=0,38, p=0,038).

Similar relationship has been established between markers of endothelial dysfunction and changes in liquorodynamics as shown by dilated lateral ventricles (for endothelial sensitivity to share stress R=-0,348, p=0,016, for FMD - R=-0,288, p=0,047, for vWF- r=0,451, р=0,001).

The level of periventricular leicoaraiosis (LA) correlated with the level of vWF (for maximal level of LA r=0,352, р=0,012, for the area of LA r=0,278, p=0,049 – on the right side =0,306; p=0,030 – on the left). Moreover, patients with LA had higher level of MAU than patients without LA (49(27-98) and 19(4-51) mg/ day, accordingly).

Conclusion: Endothelial dysfunction is in part responsible for the development of MRI-detected cerebrovascular pathology expressed as focal white matter lesions, periventricular leicoaraiosis and liqurodynamics disturbances. Also, endothelial dysfunction accompanies nephropathia and early structural changes in the brain in patients with AH and DM type2.