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Glukoz metabolizma bozukluklarında subklinik aterosklerozun değerlendirilmesi

Yıl 2018, Cilt: 57 Sayı: 4, 185 - 190, 03.12.2018

Elçin Aydın , Cihan Altın Sinan Emre Muhteşem Ağıldere Mustafa Agah Tekindal

https://doi.org/10.19161/etd.416642

Öz

Amaç: Diyabet (D) ve prediyabette (PD) vasküler yapıların ve gözün etkilenmesi bilinen bir komplikasyondur. Çalışmamızda PD ve D hastalarında damarsal yapılardaki değişiklikleri karotis intima-media kalınlığı (KIMK) ve epikardiyal yağ kalınlığı (EYK) ölçerek ateroskleroz gelişim riski açısından, gözde ise optik koherens tomografi anjiografi (OKTA) kullanarak retinal ve koroidal vasküler değişiklikler açısından sunmayı amaçladık.
Gereç ve Yöntem: Çalışmamızda Mayıs 2017- Haziran 2017 tarih aralığındaki laboratuar verilerine göre prediyabet ve diyabet tanısı alan hastalarda KIMK, EYK ölçümü ile ateroskleroz riski ve OKTA tekniği ile retinal ve koroidal vasküler değişiklikler; 19 prediyabetik, 12 diyabetik olguda, hastaların yaşı ve cinsiyeti benzer olan 31 normal kan şekeri seviyesine sahip bilinen koroner arter hastalığı olmayan kontrol (K) grubu ile karşılaştırılarak kaydedildi.
Bulgular: Diyabetik 12 hasta (7 kadın, 5 erkek, ortalama yaş 54.2±6.2), PD 19 hasta (ortalama yaş 51±8.6, 11 kadın, 8 erkek) ve 31 K grubu (ortalama yaş 50,9±11.2, 18 kadın, 13 erkek) çalışmaya dahil edilmiştir. KIMK en yüksek diyabetli hastalarda, daha sonra PD ve en az miktarda kontrol hastalarında bulunmuştur. EYK'de gruplar arası farklılık ayırtedilmedi. OKTA verilerine göre en sık bulgu non-perfüzyon, FAZ (foveal avaskuler zon) erozyonu ve venöz göllenme olup en fazla diyabetli hastalarda, sonra PD ve en az K grubunda izlenmiştir.
Sonuç: Subklinik aterosklerozun belirteçleri olan KIMK ve EFT’ye ek olarak retinal vasküler hastalıkların OKTA ile girişimsel olmayan yöntemlerle değerlendirmesinde glukoz metabolizması bozukluğu olan hastaların risk değerlendirilmesinde katkı sağlayacaktır.

Anahtar Kelimeler

Prediyabet diyabet ateroskleroz karotis intima media kalınlığı epikardiyal yağ kalınlığı optik koherens tomografi anjiografi.

Kaynakça

  • The DECODE Study Group on behalf of the European Diabetes Epidemiyology Group: Glucose tolerance and cardiovascular mortality, comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med 2001;161(3):397-404.
  • Ahluwalia N, Drouet L, Ruidavets JB, et al. Metabolic syndrome is associated with markers of subclinical atherosclerosis in a French population-based sample. Atherosclerosis 2006;186(2):345-53.
  • Ahn SG, Lim HS, Joe DY, et al. Relationship of epicardial adipose tissue by echocardiography to coronary artery disease. Heart 2008;94(3):7.
  • Altın C, Sade LE, Gezmiş E, Yılmaz M, Özen N, Müderrisoğlu H. Assessment of epicardial adipose tissue and carotid/femoral intima media thickness in insulin resistance. J Cardiol 2016;67(10):961-9.
  • Lee J, Rosen R. Optical coherence tomography angiography in diabetes. Curr Diab Rep 2016;16(12):123. de Barros Garcia JMB, Isaac DLC, Avila M. Diabetic retinopathy and OCT angiography: Clinical findings and future perspectives. Int J Retina Vitreous 2017;13(3):14.
  • Dimitrova G, Chihara E, Takahashi H, Amano H, Okazaki K. Author Response: Quantitative retinal optical coherence tomography angiography in patients with diabetes without diabetic retinopathy. Invest Ophthalmol & Vis Sci 2017;58(3):1767.
  • American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010;33(Suppl 1):62-9.
  • Unwin N, Shaw J, Zimmet P, Alberti KG. Impaired glucose tolerance and impaired fasting glycemia: The current status on definition and intervention. Diabet Med 2002;19(9):708-23.
  • Simon A, Gariepy J, Chironi G, Megnien JL, Levenson J. Intima-media thickness: A new tool for diagnosis and treatment of cardiovascular risk. J Hypertens 2002;20(2):159-69.
  • Poredos P. Intima-media thickness: Indicator of cardiovascular risk and measure of the extent of atherosclerosis. Vasc Med 2004;9(1):46-54.
  • Lim TK, Lim E, Dwivedi G, Kooner J, Senior R. Normal value of carotid intima-media thickness: A surrogate marker of atherosclerosis: quantitative assessment by B-mode carotid ultrasound. J Am Soc Echocardiogr 2008;21(2):112-6.
  • Cardellini M, Marini MA, Frontoni S, et al. Carotid artery intima-media thickness is associated with insulin- mediated glucose disposal in nondiabetic normotensive offspring of type 2 diabetic patients. Am J Physiol Endocrinol Metab 2007;292(1):347-52.
  • O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 1999;340(1):14-22.
  • Mancia G, Fagard R, Narkiewicz K, et al. List of authors Task Force members: 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 2013;31(10):1925-38.
  • Iacobellis G, Assael F, Ribaudo MC, et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 2003;11(2):304-10.
  • Smith HL, Willius FA. Adiposity of the heart: A clinical study of one hundred and thirty six obese patients. Ann Intern Med 1933;52: 911-31.
  • Taguchi R, Takasu J, Itani Y, et al. Pericardial fat accumulation in men as a risk factor form coronary artery disease. Atherosclerosis 2001;157(1):203-9.
  • Iacobellis G, Ribaudo MC, Assael F, et al. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: A new indicator of cardiovascular risk. J Clin Endocrinol Metab 2003;88(11):5163-8.
  • Gastaldelli A, Basta G. Ectopic fat and cardiovascular disease: What is the link? Nutr Metab Cardiovasc Dis 2010;20(7):481-90.
  • Iacobellis G, Leonetti F. Epicardial adipose tissue and insulin resistance in obese subjects. J Clin Endocrinol Metab 2005;90(11):6300-2.
  • Sengul C, Cevik C, Ozveren O ve ark. Echocardiographic epicardial fat thickness is associated with carotid intima-media thickness in patients with metabolic syndrome. Echocardiography 2011;28(8):853-8.
  • Ahn SG, Lim HS, Joe DY, et al. Relationship of epicardial adipose tissue by echocardiography to coronary artery disease. Heart 2008;94(3):e7.
  • Mazurek T, Zhang L, Zalewski A, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation 2003;108(20):2460-6.
  • Kessels K, Cramer MJ, Veldhuis B. Epicardial adipose tissue imaged by magnetic resonance imaging: An important risk marker of cardiovascular disease. Heart 2006;92(2):262.
  • Iacobellis G. Imaging of visceral adipose tissue: An emerging diagnostic tool and therapeutic target. Curr Drug Targets Cardiovasc Hematol Dis 2005;5(4):345-53.
  • Ishibazawa A, Nagaoka T, Takahashi A, et al. Optical coherence tomography angiography in diabetic retinopathy: A prospective pilot study. Am J Ophthalmol 2015;160(1):35-44.
  • Hwang TS, Jia Y, Gao SS, et al. Optical coherence tomography angiography features of diabetic retinopathy. Retina 2015;35(11):2371-6.
  • Iacobellis G, Leonetti F, Di Mario U. Images in cardiology: Massive epicardial adipose tissue indicating severe visceral obesity. Clin Cardiol 2003;26(5):237.

Assestment of subclinical atherosclerosis in glucose metabolism disorders

Yıl 2018, Cilt: 57 Sayı: 4, 185 - 190, 03.12.2018

Elçin Aydın , Cihan Altın Sinan Emre Muhteşem Ağıldere Mustafa Agah Tekindal

https://doi.org/10.19161/etd.416642

Öz

Aim: It is a well-known complication that diabetes (DM) and prediabetes (PD) affectsvascular structures and eye. In our study we aim to find out the atherosclerotic changes in patients with PD and DM by using carotis intima-media thickness (CIMT), epicardial fat thickness (EFT) and rusing optical coherence tomography angiography (OCTA).

Materials and Methods: Between May 2017- June 2017 consecutive 19 patients with PD and 12 patients with D were enrolled into the study. They compared with age sex matched control (C) group consisted of 31 individuals who have normal blood glucose levels. Patients with coronary artery disease was excluded. Measurements of CIMT, EFT and retinal and choroidal vascular changes by using OCTA technique obtained from our study group were recorded and compared with each other.

Results: Twelve patients with D (5 male,7 female, mean age 54.2±6.2), 19 patients with PD (8 male, 11 female, mean age 51±8.6) and 31 C group (13 male, 18 female, mean age 50.9±11.2) were included in the study. The highest value of CIMT was found in patients wih D following by patients with PD and control group had the lowest values. There was no difference between groups in EFT. The most common findings in OCTA were non-perfussion, FAZ (foveal avascular zone) erosion and venous pooling. Similarly these findings were more frequent in patient DM following by patients with PD.

Conclusion: Non invasive measurement of CIMT, EFT and retinal vascular changes detected by OCTA are useful and feasible tools for the assessment of subclinical atheroscleoris in patients with glucose metabolism disorders.

Anahtar Kelimeler

Prediabetes diabetes mellitus atherosclerosis carotis intima media thickness epicardial fat thickness optical coherence tomography angiography.

Kaynakça

  • The DECODE Study Group on behalf of the European Diabetes Epidemiyology Group: Glucose tolerance and cardiovascular mortality, comparison of fasting and 2-hour diagnostic criteria. Arch Intern Med 2001;161(3):397-404.
  • Ahluwalia N, Drouet L, Ruidavets JB, et al. Metabolic syndrome is associated with markers of subclinical atherosclerosis in a French population-based sample. Atherosclerosis 2006;186(2):345-53.
  • Ahn SG, Lim HS, Joe DY, et al. Relationship of epicardial adipose tissue by echocardiography to coronary artery disease. Heart 2008;94(3):7.
  • Altın C, Sade LE, Gezmiş E, Yılmaz M, Özen N, Müderrisoğlu H. Assessment of epicardial adipose tissue and carotid/femoral intima media thickness in insulin resistance. J Cardiol 2016;67(10):961-9.
  • Lee J, Rosen R. Optical coherence tomography angiography in diabetes. Curr Diab Rep 2016;16(12):123. de Barros Garcia JMB, Isaac DLC, Avila M. Diabetic retinopathy and OCT angiography: Clinical findings and future perspectives. Int J Retina Vitreous 2017;13(3):14.
  • Dimitrova G, Chihara E, Takahashi H, Amano H, Okazaki K. Author Response: Quantitative retinal optical coherence tomography angiography in patients with diabetes without diabetic retinopathy. Invest Ophthalmol & Vis Sci 2017;58(3):1767.
  • American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010;33(Suppl 1):62-9.
  • Unwin N, Shaw J, Zimmet P, Alberti KG. Impaired glucose tolerance and impaired fasting glycemia: The current status on definition and intervention. Diabet Med 2002;19(9):708-23.
  • Simon A, Gariepy J, Chironi G, Megnien JL, Levenson J. Intima-media thickness: A new tool for diagnosis and treatment of cardiovascular risk. J Hypertens 2002;20(2):159-69.
  • Poredos P. Intima-media thickness: Indicator of cardiovascular risk and measure of the extent of atherosclerosis. Vasc Med 2004;9(1):46-54.
  • Lim TK, Lim E, Dwivedi G, Kooner J, Senior R. Normal value of carotid intima-media thickness: A surrogate marker of atherosclerosis: quantitative assessment by B-mode carotid ultrasound. J Am Soc Echocardiogr 2008;21(2):112-6.
  • Cardellini M, Marini MA, Frontoni S, et al. Carotid artery intima-media thickness is associated with insulin- mediated glucose disposal in nondiabetic normotensive offspring of type 2 diabetic patients. Am J Physiol Endocrinol Metab 2007;292(1):347-52.
  • O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 1999;340(1):14-22.
  • Mancia G, Fagard R, Narkiewicz K, et al. List of authors Task Force members: 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 2013;31(10):1925-38.
  • Iacobellis G, Assael F, Ribaudo MC, et al. Epicardial fat from echocardiography: a new method for visceral adipose tissue prediction. Obes Res 2003;11(2):304-10.
  • Smith HL, Willius FA. Adiposity of the heart: A clinical study of one hundred and thirty six obese patients. Ann Intern Med 1933;52: 911-31.
  • Taguchi R, Takasu J, Itani Y, et al. Pericardial fat accumulation in men as a risk factor form coronary artery disease. Atherosclerosis 2001;157(1):203-9.
  • Iacobellis G, Ribaudo MC, Assael F, et al. Echocardiographic epicardial adipose tissue is related to anthropometric and clinical parameters of metabolic syndrome: A new indicator of cardiovascular risk. J Clin Endocrinol Metab 2003;88(11):5163-8.
  • Gastaldelli A, Basta G. Ectopic fat and cardiovascular disease: What is the link? Nutr Metab Cardiovasc Dis 2010;20(7):481-90.
  • Iacobellis G, Leonetti F. Epicardial adipose tissue and insulin resistance in obese subjects. J Clin Endocrinol Metab 2005;90(11):6300-2.
  • Sengul C, Cevik C, Ozveren O ve ark. Echocardiographic epicardial fat thickness is associated with carotid intima-media thickness in patients with metabolic syndrome. Echocardiography 2011;28(8):853-8.
  • Ahn SG, Lim HS, Joe DY, et al. Relationship of epicardial adipose tissue by echocardiography to coronary artery disease. Heart 2008;94(3):e7.
  • Mazurek T, Zhang L, Zalewski A, et al. Human epicardial adipose tissue is a source of inflammatory mediators. Circulation 2003;108(20):2460-6.
  • Kessels K, Cramer MJ, Veldhuis B. Epicardial adipose tissue imaged by magnetic resonance imaging: An important risk marker of cardiovascular disease. Heart 2006;92(2):262.
  • Iacobellis G. Imaging of visceral adipose tissue: An emerging diagnostic tool and therapeutic target. Curr Drug Targets Cardiovasc Hematol Dis 2005;5(4):345-53.
  • Ishibazawa A, Nagaoka T, Takahashi A, et al. Optical coherence tomography angiography in diabetic retinopathy: A prospective pilot study. Am J Ophthalmol 2015;160(1):35-44.
  • Hwang TS, Jia Y, Gao SS, et al. Optical coherence tomography angiography features of diabetic retinopathy. Retina 2015;35(11):2371-6.
  • Iacobellis G, Leonetti F, Di Mario U. Images in cardiology: Massive epicardial adipose tissue indicating severe visceral obesity. Clin Cardiol 2003;26(5):237.
Toplam 28 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Elçin Aydın 0000-0003-0907-3647

Cihan Altın 0000-0002-3996-5681

Sinan Emre 0000-0001-9829-7268

Muhteşem Ağıldere 0000-0003-4223-7017

Mustafa Agah Tekindal 0000-0002-4060-7048

Yayımlanma Tarihi 3 Aralık 2018
Gönderilme Tarihi 13 Ağustos 2017
Yayımlandığı Sayı Yıl 2018Cilt: 57 Sayı: 4

Kaynak Göster

Vancouver Aydın E, Altın C, Emre S, Ağıldere M, Tekindal MA. Glukoz metabolizma bozukluklarında subklinik aterosklerozun değerlendirilmesi. ETD. 2018;57(4):185-90.
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