DIABETES MELLITUS 2ND TYPE WITH CARDIOVASCULAR AUTONOMIC NEUROPATHY

Aim. To perform the analysis of some parameters of insulin resistance, concentration of N-terminal natriuretic pro-brain peptide (NT-prоBNP), hi-sensitive С-reactive proteine (hsCRP) and some proand anti-inflammatory cytokines in diabetes mellitus patients with diabetes mellitus 2nd type (DM2) with cardiovascular autonomic neuropathy (CAN).

Material and methods.   Totally 48 patients studied with DM2, of those 12 without verified cardiovascular diseases (CVD), 36 patients with functional stage of CAN, age 50-59 y., DM2 1-6 y. duration, HbA1c 7,1±0,6%. Controls: 15 same age almost healthy persons (р>0,05). The screening for CAN was performed that included 5 cardiovascular tests, the data from ambulatory blood pressure monitor was analyzed, ECG; and echocardiography, HbA1c, insulin (IRI), NT-proBNP, hsСRP, tumor necrosis factor-a (TNF-a), interleukin (IL)-6, IL-8 и IL-10. The Index of insulin resistance was calculated (НОМА-IR), coefficient TNF-a/IL-10.

Results.   In DM2 patients with CAN there was an increase of insulin resistance values, e. g. IRI concentration (26,6±1,73 mcIU/ml, р<0,001 — comparing to controls; р1 <0,001 — patients with DM2 not CVD), НОМА-IR (8,56±0,72, р<0,001, р1 <0,01); levels of proinflammatory cytokines TNF-a (5,75±0,24 pg/ml, р<0,001, р1 <0,001), IL-6 (5,88±0,38 pg/ml, р<0,001, р1 <0,001), IL-8 (6,65±0,3 pg/ml, р<0,001, р1 >0,05); and hsCRP (2,77±0,24 pg/L, р<0,001, р1 <0,001) and coefficient TNF-a/IL-10 (44,2±3,57%, р<0,01, р1 <0,05). Addition of CAN is associated with the increase of NTproBNP (407,0±23,0 fmol/ml, р<0,001, р1 <0,001), that correlates with the growth of the left ventricle myocardial mass (LVMM) (r=0,52, p<0,05).

Conclusion. In DM2 patients with the functional stage of CAN there is an increase of IRI, НОМА-IR; concentrations of NT-prоBNP, hsСRP, TNF-a, IL-6, IL-8 и IL-10. there is also an increase of TNF-a/IL-10, that witnesses for the compensatory type of cytokine balance. The level of NT-prоBNP in DM2 patients correlates with LVMM that is associated with CAN development.

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