Endothelial dysfunction and cerebrovascular pathology in patients with diabetes mellitus
Kharkiv National Medical University, Ukraine
Cerebrovascular disorders are a very important medical−social problems frequently caused by diabetes. Progression and bad prognosis of cerebrovascular disorders in patients with type 2 diabetes mellitus are determined by endothelial dysfunction, which results from negative influences of hyperglycemia, protein glycolization, development of oxidative stress. The purpose of investigation was to detect the relationships between hemodynamic and metabolic disorders in patients with type 2 diabetes mellitus and diabetic encephalopathy. The study involved 87 patients with type 2 diabetes mellitus and stage 2 diabetic encephalopathy. Glycolyzed hemoglobin ranged from 7.2 % to 8.8 %. The examination included neurological, hemodynamic, biochemical and statistical. Decreased blood flow velocity in the aa. carotis int. by 32.9 %, aa. cerebri med. by 35.2 %, aa. vertebralis by 45.1 %, a. basilaris by 32.1 % and 1.8 and 1.75 times, respectively, increased pulsatility index and circulatory resistance index compared to the controls were revealed. Five times increased pool of damaged circulating endothelial cells and level of endothelin−1 increased in 1.9 times were observed. The correlation analysis confirmed the pathogenetic vasoconstrictor effect of endothelin−1 on the cerebral vessels and the link between the violation of carbohydrate metabolism and endothelial cell damage in patients with stage 2 diabetic encephalopathy. Thus, diabetic encephalopathy in patients with type 2 diabetes mellitus is the result of combined effect of metabolic and hemodynamic factors, among which an important role is played by endothelial dysfunction, which is a strategically important therapeutic target in the treatment and prevention of cerebrovascular complications of diabetes.
Key words: type 2 diabetes mellitus, diabetic encephalopathy, cerebrovascular disorders, endothelial dysfunction.