超声检测血管内皮功能的方法学及观测指标

心血管疾病的发生发展，多以心血管内皮功能障碍开始。对长期接触血管内皮损伤危险因子的人群，进行血管内皮功能的早期检测，发现异常，早期采取对策，对预防及延缓心血管疾病发生发展，具有较为重要的意义。采用高分辨率超声检测血管内皮功能，获得与有创方法相似的结论，但在方法学及观测指标上有所不同，现作一简要综述。     

血管内皮功能的检测和临床应用

近年来,越来越多的研究表明血管内皮功能在心血管疾病的发生和发展中起到重要作用,内皮功能的失调也被认为是心血管疾病的一个重要危险因素。然而对于内皮功能测量的最好方法仍存在许多争议,本文将就血管内皮舒张功能的原理、内皮功能在临床上的测量特别是血流介导的血管舒张功能（Flow—mediated dilatation,FMD）测量、内皮功能在心血管疾病诊断中的临床应用进行讨论。     

血管内皮功能高频超声检测法的评价

血管内皮通过释放一氧化氮(NO)及其他血管活性物质，在调节血管张力，抑制血小板聚集及平滑肌细胞增生等方面起着十分重要的作用。人们在实验性研究和临床研究中发现：心血管疾病常伴发内皮功能不全，而内皮细胞损伤导致的内皮功能不全又加重心血管疾病，两者密切相关。以往对血管内皮功能的研究常采用实验室检查、内皮细胞计数及形态学检查等方法，     

血管内皮细胞的功能以及损伤修复与动脉粥样硬化

目的:血管内皮细胞具有多种功能,对其功能检测也有多种方法,血管内皮功能障碍与动脉粥样硬化的发生发展有着密切的关系。资料来源:应用计算机检索Pubmed数据库1990-01/2006-08血管内皮功能以及动脉粥样硬化的相关文章,检索词“vascular endothelial cell,artherosclerosis”,限定文章种类为English;同时检索中国期刊全文数据库2000-01/2006-08相关文章,检索词为“血管内皮细胞、动脉粥样硬化”,限定文章语言种类为中文。资料选择:对资料进行初审,选取符合研究要求的有关文章找全文。纳入标准:①有关血管内皮功能的研究。②有关动脉粥样硬化的研究。排除标准:重复或类似的同一研究、个案报道等。资料提炼:共收集500篇有关血管内皮功能及动脉粥样硬化的文章,排除重复或类似的同一研究,120篇符合研究要求。资料综合:①血管内皮的生理功能:具有屏障、信息的传递和内分泌、参与血管形成等多种生理功能。②血管内皮功能的常用检测方法:包括内皮细胞分泌物的直接检测、反映内皮细胞功能的分子标记物、冠脉造影法测量血管内皮功能、高分辨率超声评价动脉内皮功能。③血管内皮细胞功能障碍与动脉粥样硬化:动脉粥样硬化的发生是由于血管内皮细胞和平滑肌细胞受各种危险因子的损伤,而使血管局部产生的一种过度的慢性炎性增生反应。研究显示,内皮功能不良的患者在其随访过程中心血管疾病的发生明显增多,且结果与内皮功能检测方法的差异无关。④血管内皮细胞功能障碍的治疗:包括运动、替代疗法、内皮源性收缩剂的抑制剂或拮抗剂、细胞保护剂、调脂治疗、内皮种植及基因治疗。结论:血管内皮具有多种功能,随着对血管内皮功能及其功能障碍深入的研究,将实现更早期的发现内皮功能障碍,更有效地指导对血管内皮细胞损伤的早期修复,保护血管内皮功能从而有效地防治动脉硬化的发生与发展。     

情绪因素对健康人心血管及神经内分泌系统的影响初探

目的:选择悲志等情志为观察点,通过人情志刺激实验的研究,揭示情志因素对健康人神经内分泌作用及对血管内皮功能的影响,探讨情志因素对冠心病等心血管疾病发病的作用及机理,为减少与控制心血管疾病发病因素提供新的客观依据.方法:本研究通过电影诱导方式观察情志刺激对人的神经内分泌及血管内皮功能的影响.所有研究指标的结果建立数据库,使用"SPSSlO.O"统计软件.应用两独立样本均数比较的方法进行统计学处理.结果:情志能够影响健康人心血管神经内分泌系统及血管内皮功能(P<0.05).结论:情志因素可以通过神经内分泌系统和血管内皮功能的改变影响心血管疾病的发生发展.     

血清尿酸浓度与血管内皮功能的关系

目的本文应用高分辨率彩超检测血管内皮功能,探讨血清尿酸(UA)与血管内皮功能的关系。方法应用彩超检测血管内皮功能。采用自动生化分析仪检测UA。结果血管内皮功能障碍组血清UA浓度高于正常组(P<0.05)。结论UA与血管内皮功能有关,可能参与了血管内皮功能障碍的发生发展过程;应用高分辨率彩超评价血管内皮功能的方法有很高的临床实用价值。     

肥胖人群应用彩超检测血管内皮功能的临床意义

目的应用高分辨率彩超检测血管内皮功能，探讨血管内皮功能与肥胖的关系。方法应用彩超检测血管内皮功能，测量并计算体重指数、腰臀比。结果血管内皮功能障碍组体重指数、腰臀比高于正常组（P〈0．05）。结论体重指数、腰臀比与血管内皮功能有关；应用高分辨率彩超检测肥胖人群血管内皮功能的方法简单准确，临床易于推广。     

超声检测血管内皮功能的研究进展

近年来血管内皮功能已成为心血管领域研究的热点,内皮功能与动脉粥样硬化密切相关,无创超声检查技术是早期检测内皮功能的有效手段,本文对血管内皮功能的超声检测方法做一简要概述。     

内皮功能的超声检测

大量研究发现,内皮功能的损伤,是许多心血管疾病如冠心病、动脉粥样硬化、高血压等的早期重要表现,甚至暴露于心血管危险因素的正常人,(如吸烟[1]、半胱氨酸血症[2]等)其内皮功能也有不同程度的损伤。尽管血管内膜释放许多化学物质,但是,尚没有一项单一的血液检测能有效地证明内皮功能正常或内皮功能早期损伤[3]。而最普遍的在体检测内皮功能的方法是测量药物或生理刺激下的内皮依赖性血管扩张,即在造影条件下通过导管观测[4],但是这种有创性检查无法在出现临床症状之前对内皮功能作出检测。因此,超声探测内皮功能这种无创、方便的检测方法,…     

彩超检测血管内皮功能与体质指数、腰臀比的关系

目的应用高分辨率彩超检测血管内皮功能,探讨血管内皮功能与体质指数、腰臀比的关系。方法应用彩超检测血管内皮功能。测量并计算体质指数、腰臀比。结果血管内皮功能障碍组体质指数、腰臀比高于正常组(P<0.05)。结论体质指数、腰臀比与血管内皮功能有关。     

The ASCEND-HF trial: an acute study of clinical effectiveness of nesiritide and decompensated heart failure

Given the prevalence of cardiovascular disease (CVD), early detection is crucial. Although traditional cardiovascular risk factors relate to future CVD, the predictive value of these risk factors can be relatively limited. Contemporary scientific attention has focused on alternative direct measures of arterial function. Based on the ability of the endothelium to acutely dilate in response to an increase in flow, ‘flow mediated dilation’ (FMD) was introduced approximately 20 years ago and is now an established non-invasive index of endothelial function predictive of future cardiovascular events. Recently, ‘low-flow mediated constriction’ (L-FMC) has been proposed as a complementary addition to FMD. The technique is based on the constrictor response to decreased flow and is claimed to improve the sensitivity and specificity of FMD. The aim of this review is to examine literature pertaining to this novel technique and to provide insight into the potential use of L-FMC in future research.     

Thiamine deficiency in diabetes mellitus and the impact of thiamine replacement on glucose metabolism and vascular disease

Despite the targeting of traditional risk factors for cardiovascular disease, disease burden has not been completely eliminated. Thiamine is an essential cofactor in carbohydrate metabolism and individuals with diabetes are thiamine deficient. The pathophysiology of recognised complications of thiamine deficiency is similar to that underlying atherosclerosis and the metabolic syndrome, namely oxidative stress, inflammation and endothelial dysfunction. This review examines the mechanisms by which thiamine deficiency occurs in individuals with diabetes, how this deficiency leads to hyperglycaemic-induced damage, and the effect of thiamine replacement on vascular disease, endothelial function and oxidative stress. Thiamine administration can prevent the formation of harmful by-products of glucose metabolism, reduce oxidative stress and improve endothelial function. The potential benefit of long-term replacement in those with diabetes is not yet known but may reduce cardiovascular risk and angiopathic complications.     

Pathophysiologic cardiovascular changes in stress and depression

Fear, anger, and grief may precipitate myocardial ischemia and infarction. The prognosis of patients with inducible ischemia during mental stress is worse than in those without inducible ischemia. The sympathetic nervous system plays an important role in stress-associated changes in cardiovascular regulation and contributes to cardiovascular morbidity and mortality by inducing vasoconstriction and tachycardia, as well as arrhythmia. Hostility--previously termed type A personality--is often associated with sympathetic hyperreactivity to mental stress and carries an increased risk for atherosclerotic vascular disease. As endothelial dysfunction is an early manifestation of atherosclerosis, the impact of mental stress on endothelial function is also important. Acute mental stress induces prolonged endothelial dysfunction in healthy volunteers, which is prevented by selective endothelin A receptor antagonism. This represents an important link between mental stress and atherosclerotic vascular disease. In addition, patients with depression show hypercortisolemia, and changes in platelet function leading to a prothrombotic state. These findings help to explain the increased cardiovascular risk in patients with depression.     

血管内皮功能与冠心病

重点阐述血管内皮细胞功能和目前检测情况、冠心病的流行现状和病理基础,以及两者之间的潜在关系和影响,早期准确地评价血管内皮功能障碍,对冠心病的早期发现、诊断、治疗、预后具有重要价值。      

Erectile dysfunction correlates with left ventricular function and precedes cardiovascular events in cardiovascular high-risk patients

Erectile dysfunction (ED) is related to cardiovascular risk factors by an impairment of endothelial function. Therefore, symptoms of ED are probably to precede cardiovascular disease and events. Moreover, endothelial dysfunction is common in patients with decreased left ventricular ejection fraction (LVEF). Hence, left ventricular dysfunction probably results in a decreased erectile function. A total of 192 cardiovascular high-risk patients from the EROSS Programme (Evaluation of Role of Sexual Dysfunction in the Saarland Programme) were evaluated regarding onset and severity of ED using the IIEF-5 questionnaire. LVEF was measured with magnetic resonance imaging, angiographically or echocardiographically. Prevalence of ED was 80.6%. Patients with moderate or severe impairment of ejection fraction had a significant increase of ED (p = 0.001). Multivariate analysis identified LV dysfunction as an independent risk factor for ED independent of heart failure symptoms (p = 0.001). Moreover, symptoms of ED appeared 3.04 +/- 7.2 years prior to the cardiovascular event (p = 0.005). LVEF is an independent risk factor for the development or increase of ED in cardiovascular high-risk patients, probably caused by an impairment of endothelial function. Hence, ED is suggested to be an early symptom of generalised cardiovascular disease and events. Thus, cardiovascular evaluation is recommended in patients with ED providing the opportunity of optimised preventional treatment.     

Endothelial function in HIV-infected patients with low or mild cardiovascular risk

BACKGROUND: Highly active antiretroviral therapy for HIV-infected patients is associated with metabolic side effects, which could cause an increased cardiovascular risk in these patients. Non-invasive study of endothelial function by brachial artery ultrasound can detect subclinical atherosclerosis. Several studies have assessed endothelial function in HIV-infected patients with associated cardiovascular risk factors. OBJECTIVES: The aim of this study is to determine endothelial function in HIV-infected patients under antiretroviral therapy with low or mild coronary risk and lipid levels within the normal range. METHODS: Transversal study including 28 HIV-infected adults (15 receiving antiretroviral therapy and 13 naive) with low or mild cardiovascular risk and 12 healthy controls. Subjects with diabetes mellitus, hypertension, cardiovascular disease, obesity, high cholesterol or high triglyceride levels were excluded. Endothelial function was determined with flow-mediated dilation (FMD) of the brachial artery by ultrasound study. RESULTS: Treated HIV-infected patients had significantly lower FMD (5.93 +/- 3.56) than healthy controls (10.64 +/- 3.08, P = 0.008). Naive patients had an intermediate FMD, but this was not statistically significant. CONCLUSIONS: HIV-infected patients receiving antiretroviral therapy who have low or mild cardiovascular risk and lipid levels within the normal range have endothelial dysfunction compared with healthy controls.     

Erectile dysfunction is a signal of risk for cardiovascular disease: a primary care view

Erectile dysfunction (ED) is a multisystemic disorder with symptoms most commonly caused by vascular insufficiency. Multiple comorbidities occur frequently among men who have ED; thus ED may signal disorders with similar etiologies, including psycho-social problems, endocrine imbalances, neurologic disorders, and particularly cardiovascular risk or frank disease. Evidence is accumulating that vascular ED signals endothelial dysfunction and cardiovascular disease risk. ED may be a strong signal of increased risk of silent myocardial ischemia in men who have uncomplicated type-2 diabetes mellitus and of future symptomatic cardiovascular disease in men who do not have diabetes. ED patients should be evaluated for cardiovascular risk and frank disease because early detection may allow early treatment and decreased morbidity. The best method for evaluating men with ED for cardiovascular risk, and the role of ED as a screening test for increased cardiovascular disease risk need further study.     

Circulating endothelial progenitor cells in cardiovascular disorders

The role of vascular endothelium in cardiovascular disorders is well recognized. Mature endothelial cells contribute to the repair of endothelial injury, but only with a limited capacity. This has led to growing interest and further investigation into circulating endothelial progenitor cells (EPCs) and their role in vascular healing, repair and postnatal neovascularization. Recent studies have shown that EPCs are affected both in number and function by several cardiovascular risk factors as well as various cardiovascular disease states. Here, we aim to provide an overview of EPCs in humans, from methods of assessment to quantification and functional properties in numerous cardiovascular conditions. In addition, we hope to offer some perspective on the potential diagnostic and therapeutic aspects of EPCs.