avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2025-15-3-206-215OAAVYLavk-2006Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLEКорреляция между поражением мелких и крупных сосудов у пациентов с сахарным диабетом 2-го типаCorrelation Between Microvascular and Macrovascular Affection in Type 2 Diabetes MellitusШалтоутИнассShaltoutInass

Инасс Шалтоут — профессор, д.м.н., внутренняя медицина, эндокринология, медицинский факультет

Каир 

Inass Shaltout — Professor, M.D, Internal medicine, endocrinology 

Cairo 

inassshaltout@hotmail.comУадиМэриWadieMary

Мэри Уади — профессор, д.м.н., внутренняя медицина, медицинский факультет  

Каир 

Mary Wadie — Professor, M.D, Internal medicine

Cairo

drmarywadie@yahoo.comАттиаМазенAttiaMazen

Мазен Аттиа — преподаватель, д.м.н., внутренняя медицина, медицинский факультет 

Каир

Mazen Attia — Lecturer, M.D, Internal medicine 

Cairo

КхафагиАяKhafagyAya

Ая Кхафаги — регистратор, к.м.н., внутренняя медицина, студенческая больница 

Каир

Aya Khafagy — Registrar, Msc, Internal medicine 

Cairo

ayakhafagy248@gmail.comhttps://orcid.org/0000-0001-8705-9811ХассанСара А.HassanSarah A.

Сара А. Хассан — преподаватель, д.м.н., внутренняя медицина, медицинский факультет 

Каир

Sarah A. Hassan — Lecturer, M.D, Internal medicine 

Cairo

dr.sarah88@cu.edu.egМедицинский факультет Каирского университетаЕгипетFaculty of Medicine, Cairo UniversityEgyptСтуденческая больница Каирского университетаЕгипетStudents’ Hospital, Cairo UniversityEgypt202526052025153206215Copyright © Шалтоут И., Уади М., Аттиа М., Кхафаги А., Хассан С., 20252025Шалтоут И., Уади М., Аттиа М., Кхафаги А., Хассан С.Shaltout I., Wadie M., Attia M., Khafagy A., Hassan S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/2006

Цель работы: изучить возможную взаимосвязь между макрососудистыми заболеваниями, особенно атеросклерозом, и нарушениями микроциркуляции у пациентов с СД2, а также оценить взаимосвязь между уровнем глюкозы крови и поражением мелких и крупных сосудов. Пациенты и методы: В исследовании прияло участие 150 пациентов: 100 пациентов с СД2 и контрольная группа из 50 участников. Все участники прошли сбор анамнеза и клиническое обследование, а также сдали кровь на биохимический анализ, включая определение уровней гликированного гемоглобина (HBA1c), глюкозы плазмы натощак (FPG), постпрандиального уровня глюкозы через 2 часа (2h-PG), триглицеридов (TG), общего холестерина (TC), ЛПВП и ЛПНП. Видео-капилляроскопию ногтевого ложа (NVC) проводили с целью оценить морфологию капилляров ногтевого ложа, диаметр артерий и вен, изменения длины капилляров и размер петли, наличие или отсутствие капиллярного кровотечения, кровоподтеков, рубцевания, дефектных и крупных капилляров. Для оценки таких изменений использовали полуколичественную шкалу (0–3). Все участники прошли дуплексное исследование сонной артерии для измерения толщины слоя интима-медиа в общей сонной артерии (ТИМ). Результаты. Пациенты с СД2 имели существенно большее значение ТИМ по сравнению с контрольной группой. Отмечались более частые случаи отклонений в морфологии капилляров, кровотечений, рубцевания и дефектов капилляров. Модифицированный балл NVC у пациентов с СД2 составил >1 по сравнению с контрольной группой. Кроме того, у пациентов с СД2 наблюдались более высокие показатели частоты кровоподтеков, разветвлений, пересечений и штопоровидных капилляров, большие петли и укорочение капилляров. Зарегистрировано значительное увеличение значений ТИМ слева и справа в группе участников с СД, а модифицированный балл NVC составил >1. Заключение. Отмечена тесная связь между атеросклерозом и нарушением микроциркуляции. Видео-капилляроскопию можно использовать для оценки нарушений микроциркуляции до обнаружения атеросклероза по результатам дуплексного исследования сонной артерии.

Aim of the work: to explore the possible relation between macrovascular disease especially atherosclerosis and microcirculation abnormalities in patients with T2DM and, to assess any relationship between blood glucose level, microvascular and macrovascular affection. Patients and methods: the study recruited 150 participants; 100 patients with T2DM and 50 controls. All participants underwent history taking, clinical examination, biochemistry testing including HBA1c, FPG, 2h-PG, TG, TC, HDL, and LDL. Nailfold video capillaroscopy (NVC) was performed to evaluate morphology of the nailfold capillaries, arterial and venous limb diameter, alteration in Capillary length and loop diameter, presence or absence of capillary hemorrhage, extravasation, scarring, scanty and large capillaries. To score these alterations, a semi-quantitative rating scale (0–3) was used. Carotid duplex was done to all participants to measure the intima media thickness in the common carotid artery (CIMT). Results: Subjects with T2DM showed significantly increased CIMT when compared with controls. There were a significantly higher frequencies of abnormal capillary morphology, hemorrhage, scarring and scanty capillaries, Modified NVC score>1 in T2DM. In comparison to the control group, they also exhibited noticeably greater rates of extravasation, branching, crossed, and corkscrew-shaped capillaries, larger loops, and decreased capillary length. There was significantly higher left and right CIMT in the group of diabetics with Modified NVC score >1. Conclusion: A significant relationship was found between atherosclerosis and microcirculation abnormalities. Videocapilloroscopy could be used to assess microcirculatory abnormalities before detection of atherosclerosis by carotid duplex.

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