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1.
目的观察卡维地洛对慢性心力衰竭(chronic heart failure,CHF)患者血管内皮功能的影响,同时观察卡维地洛对患者细胞因子的影响以及与心功能的相关性.方法入选CHF患者52例,随机分为常规抗CHF治疗组(25例)和卡维地洛组(27例),后者在常规抗CHF治疗基础上加用卡维地洛.疗程为12周.正常对照组为健康者(26例).所有CHF患者治疗前后均测定左室舒张末期内径(LVDd)和收缩末期内径(LVDs)、左室射血分数(LVEF)、肱动脉反应性充血状态下血管内径和血流量的变化、血一氧化氮(nitrogen monoxide,NO)、内皮素(endothelin,ET 1)、肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、白介素-6(interleukin-6,IL-6)等指标.结果CHF患者肱动脉反应性充血状态下血管内径扩张程度和血流量增加程度均低于正常对照组(P<0.01),CHF患者血NO、ET 1、TNF-α、IL-6等指标均高于正常对照组(P <0.01).12周治疗后,卡维地洛组改善肱动脉反应性充血状态下血管内径扩张程度和血流量增加程度均优于常规抗CHF治疗组(P<0.01),改善LVDd、LVDs和LVEF均优于常规抗CHF治疗组(P<0.01).同时,卡维地洛组ET-1、IL-6等指标的下降也优于常规抗CHF治疗组(P<0.01或P<0.05).另外,52例CHF患者治疗前LVEF值与TNF-α值或IL-6值存在一定的负相关,相关系数分别是r=-0.55(P<0.01)和r=-0.57(P<0.01).结论CHF患者存在着内皮功能紊乱,TNF-α及IL-6等细胞因子被激活;卡维地洛可有效改善CHF患者的心功能和血管内皮功能,缩小心腔,降低TNF-α及IL-6等细胞因子.  相似文献   

2.
用高分辨率彩色多普勒超声检测33例2型糖尿病(T2DM)患者肱动脉反应性充血后,以及含服硝酸甘油后的血管内径和血流量变化.结果T2DM组反应性充血时肱动脉内径变化比正常对照组明显减弱(P<0.01),硝酸甘油介导的肱动脉内径扩张与正常对照组比较有显著性差异(P<0.05).结论T2DM患者不仅存在血管内皮依赖性舒张功能障碍,而且还存在非血管内皮依赖性舒张功能障碍.  相似文献   

3.
高频超声评价高血压患者血管内皮功能的研究   总被引:1,自引:0,他引:1  
目的:探讨高血压对血管内皮功能的影响。方法:应用高频超声检测48例原发性高血压患者和45例血压正常的健康人在静息状态、反应性充血后以及舌下含服硝酸甘油后的肱动脉内径变化。结果:原发性高血压患者反应性充血引起肱动脉内径扩张显著低于血压正常的健康人(7.62%±5.10%)vs(14.53%±3.82%),P<0.01,舌下含服硝酸甘油引起肱动脉内径扩张差异无统计学意义(18.23%±3.20%)vs(18.87%±4.35%),P>0.05。结论:原发性高血压患者存在血管内皮依赖性舒张功能受损,高频超声可以是评价血管内皮功能的无创、简单、可靠的方法。  相似文献   

4.
目的探讨彩超检测对高血压患者血管内皮功能的临床意义。方法选取本院2013年12月~2014年12月收治的高血压患者77例为观察组,并在同年选取健康体检志愿者46例为对照组。对高血压组应用彩超检测,观察反应性充血前后的肱动脉内径的变化,并与对照组进行比较。结果检测结束后,高血压组的肱动脉内径基础值为(3.67±0.23),低于对照组的肱动脉内径基础值(4.81±0.43),差异有统计学意义(P0.05);高血压组反应性充血后的肱动脉内径扩张值为(9.86±1.42),显著低于对照组反应性充血后的肱动脉内径扩张值(12.95±1.78),差异有统计学意义(P0.05)。结论对于高血压患者而言,采用彩超检测血管内皮功能,能有效提高评价的准确性,并对高血压并发症进行有效的预防和治疗,具有较高的临床价值,值得在临床中广泛推广和应用。  相似文献   

5.
目的探讨应用超声血管反应性充血法评估血管内皮舒张功能的可行性和可靠性。方法 12名中青年健康体检者(健康对照组)和10例中青年心肌梗死患者(心肌梗死组)接受肱动脉超声检查,比较两组肱动脉反应性充血前后血管内径及血流量变化百分率。结果肱动脉基础内径及基础血流量两组间比较差异无统计学意义。反应性充血后血管内径变化百分率健康对照组显著高于心肌梗死组(13.6%±6.6%比7.2%±2.3%,P<0.05),反应性充血后血流量变化百分率健康对照组显著高于心肌梗死组(398.6%±150.4%比283.8%±146.3%,P<0.05)。结论肱动脉超声检查间接评价血管内皮功能,测定准确、操作简便、无创性、可重复检测且可提供动脉壁的解剖学图像。  相似文献   

6.
目的应用多普勒超声技术,评价硝苯地平对原发性高血压(EH)患者血管内皮功能的影响。方法将124例EH患者随机均分为两组,治疗组口服硝苯地平,对照组口服珍菊降压片,疗程均为12个月。采用彩色多普勒超声仪测定患者的肱动脉内径,比较两组治疗前后肱动脉内径变化,计算反应性充血后肱动脉内径变化百分率和硝酸甘油诱发的肱动脉内径百分变化率。结果治疗后治疗组反应性充血后肱动脉内径百分变化率明显高于对照组(P〈0.01),两组硝酸甘油诱发的肱动脉内径百分变化率比较无统计学差异(P〉0.05)。结论硝苯地平可改善EH患者受损的内皮依赖性血管舒张功能。  相似文献   

7.
目的:观察卡维地洛对慢性心力衰竭(心衰)患者血管内皮功能的影响,同时观察卡维地洛对患者细胞因子的影响以及与心功能的相关性.方法:入选慢性心衰患者50例,随机分为常规抗心衰组(24例)和卡维地洛组(26例),后者在常规抗心衰治疗基础上加用卡维地洛.疗程为12周.正常对照组为健康者(26例).所有慢性心衰患者治疗前后均测定左心室舒张末期内径(LVDd)和左心室收缩末期内径(LVDs)、左心室射血分数、肱动脉反应性充血状态下血管内径和血流量的变化、血一氧化氮、内皮素-1、肿瘤坏死因子α、白细胞介素-6等指标.结果:2组慢性心衰患者肱动脉反应性充血状态下血管内径扩张程度和血流量增加程度均低于正常对照组(P<0.01),血一氧化氮、内皮素-1、肿瘤坏死因子α、白细胞介素-6等指标均高于正常对照组(P<0.01).治疗12周后,卡维地洛组改善肱动脉内皮依赖性舒张功能优于常规抗心衰组(P<0.01),改善LVDd、LVDs和左心室射血分数均优于常规抗心衰组(P<0.01).同时,卡维地洛组内皮素-1、白细胞介素-6等指标的下降也优于常规抗心衰组(P<0.01和P<0.05).另外,50例慢性心衰患者治疗前左心室射血分数与肿瘤坏死因子α和白细胞介素-6存在一定的负相关(r=-0.56,P<0.01)和(r=-0.57,P<0.01).结论:慢性心衰患者存在着内皮功能紊乱,肿瘤坏死因子α及白细胞介素-6等细胞因子被激活;卡维地洛可改善慢性心衰患者的心功能和血管内皮功能,缩小心腔,降低肿瘤坏死因子α及白细胞介素-6等细胞因子.  相似文献   

8.
用高分辨率彩色多普勒超声检测33例2型糖尿病(T2DM)患者肱动脉反应性充血后,以及含服硝酸甘油后的血管内径和血流量变化。结果:T2DM组反应性充血时肱动脉内径变化比正常对照组明显减弱(P〈0.01),硝酸甘油介导的肱动脉内径扩张与正常对照组比较有显著性差异(P〈0.05)。结论:T2DM患者不仅存在血管内皮依赖性舒张功能障碍,而且还存在非血管内皮依赖性舒张功能障碍。  相似文献   

9.
目的评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的血管内皮功能。方法OSAHS患者30例(轻度组8例,中重度组22例)及对照组10例,分别用高分辨率超声检测基础状态、反应性充血时(内皮依赖性血管扩张)以及含服硝酸甘油后(非内皮依赖性血管扩张)的肱动脉内径,计算不同状态下肱动脉的扩张率以评估血管内皮功能。结果对照组、轻度和中重度OSAHS组患者反应性充血时肱动脉内径扩张率分别为(15.2±2.6)%、(14.3±3.2)%和(9.8±4.9)%,中重度OSAHS组患者血管内皮介导的舒张反应较对照组和轻度OSAHS组明显降低;含服硝酸甘油后肱动脉内径扩张率分别为(16.5±5.0)%、(15.7±4.1)%和(14.1±6.2)%,3组间无明显差别。结论中重度OSAHS患者存在血管内皮功能障碍,OSAHS本身可能是导致血管内皮损伤的重要因素。  相似文献   

10.
目的研究川崎病(KD)急性期肱动脉内皮依赖性血管舒张(EDD)功能及快速经静脉输注维生素C的作用。方法应用高分辨力超声分别测定KD急性期患者及对照组反应性充血介导的肱动脉内径百分变化率,并测定快速经静脉输注维生素C后反应性充血介导的肱动脉内径百分变化率。结果KD急性期组反应性充血介导肱动脉内径百分变化率明显低于对照组(P<0.01),其中并发冠状动脉扩张者与未并发冠状动脉扩张者间差异无统计学意义(P>0.05)。KD急性期患者快速经静脉输注维生素C后反应性充血介导肱动脉内径百分变化率较前明显增加(P<0.01)。结论KD急性期外周动脉内皮功能减低,经静脉快速输注大剂量维生素C可以改善KD急性期外周动脉内皮功能。  相似文献   

11.
目的探讨长期应用氯吡格雷对冠心病患者血管内皮功能的保护作用。方法将166例经冠状动脉造影确诊为冠心病的患者(均予裸支架植入治疗)随机分为试验组和对照组,治疗的前6个月两组均应用氯吡格雷和阿司匹林6个月,6个月后对照组只应用阿司匹林,试验组继续应用氯吡格雷和阿司匹林6个月(其他冠心病基础用药一致)。分别于治疗6个月、12个月采用肱动脉超声和上臂反应性充血试验的方法观察并比较两组肱动脉舒张期内径、平均血流速度、血流量、动脉扩张性、血流阻力和肱动脉中膜厚度等反映患者血管内皮功能的指标。结果试验组肱动脉管径、血流速度、血流量和扩张性增加,血流阻力和肱动脉内膜中膜厚度降低;其应用12个月比6个月效果更明显。治疗12个月后试验组比对照组血管内皮功能指标改善更明显(P<0.05)。在反应性充血状态下,试验组肱动脉管径、血流速度、血流量增加,血流阻力降低;而对照组血流速度、血流量、血流阻力、肱动脉管径等指标治疗12个月与治疗6个月差异无统计学意义(P>0.05)。结论长期应用氯吡格雷对冠心病患者血管内皮功能可能有保护作用。  相似文献   

12.
OBJECTIVE: To examine the effect of handgrip exercise induced ischaemia on non-invasive assessment of endothelial function in the brachial artery. DESIGN AND SETTING: High frequency ultrasound was used to measure brachial artery diameter at rest and after reactive hyperaemia induced by forearm cuff occlusion with and without handgrip exercise induced ischaemia. SUBJECTS: 10 healthy subjects, < 40 years, without known cardiovascular risk factors. MAIN OUTCOME MEASURES: Brachial artery dilatation and blood flow. RESULTS: Hyperaemia following forearm occlusion with handgrip exercise induced ischaemia increased brachial artery diameter significantly more than hyperaemia following occlusion alone, 6.9 (3.2)% and 4.5 (1.6)%, respectively (95% confidence interval 0.3% to 4.5%). There was no difference in peak blood flow with and without exercise induced ischaemia CONCLUSIONS: Handgrip exercise induced ischaemia with forearm occlusion caused more pronounced brachial artery dilatation than occlusion alone without change in peak blood flow. This suggests continued brachial artery responsiveness to the stimulus of ischaemia despite maximum blood flow and peripheral vasodilatation with occlusion alone.  相似文献   

13.
OBJECTIVE: To study whether haemostasis function variables correlate with endothelial function and other vasomotion characteristics of the brachial artery in a randomly selected healthy population of 35-year-old men and women. DESIGN: Endothelial function was measured as flow mediated dilatation (FMD) of the brachial artery during reactive hyperaemia and the nonendothelial dependent dilatation after sublingual nitroglycerin (NTG) was administered. Haemostasis and fibrinolysis function were estimated by analysis of von Willebrand factor, plasminogen activator inhibitor-1, antiplasmin and fibrinogen. SETTING: A general medicine research centre and a university hospital. SUBJECTS: Randomly chosen men (n = 53) and women (n = 56). RESULTS: Univariate correlation analysis showed significant correlations between haemostasis factors, conventional risk factors for cardiovascular disease and indices of vasomotion of the brachial artery. In multivariate analysis, with haemostasis variables and conventional risk factors included, antiplasmin was the strongest explanatory variable for FMD. When antiplasmin was removed from the analysis, the r-value dropped from 0.46 to 0.35. Antiplasmin also correlated with NTG-induced dilatation (positively) and brachial diameter at rest (negatively), albeit less consistently. CONCLUSIONS: Antiplasmin correlates significantly and independently to FMD, reflecting endothelial function, and also to brachial artery diameter at rest and nitroglycerin-induced dilatation. In multivariate analysis these correlations of antiplasmin to arterial characteristics were stronger than for 'conventional' risk factors, such as smoking, blood pressure and serum cholesterol.  相似文献   

14.
OBJECTIVE: To examine the relation between endothelial dependent and endothelial independent stimuli of varying intensity and measures of vascular function in the brachial artery of young healthy adults, to determine whether these responses are consistent and can be used to assess endothelial function. DESIGN AND SETTING: High resolution ultrasound was used to measure brachial artery diameter at rest, after reactive hyperaemia induced by forearm cuff occlusion, and after sublingual isosorbide dinitrate (ISDN). Each subject was assigned to a random order of six cuff occlusion times (30 seconds, 1.5, 2.5, 3.5, 4.5, and 8 minutes) and six doses of ISDN (10, 20, 50, 100, 200, and 400 micrograms). SUBJECTS: Three males and three females mean age 31 years (range 25 to 43) with no known risk factors for cardiovascular disease. MAIN OUTCOME MEASURES: Flow mediated, endothelial dependent dilatation was compared to duration of cuff occlusion, peak reactive hyperaemia, and duration of increased flow. Nitrate induced, endothelial independent dilatation was compared to dose of ISDN and change in flow. RESULTS: Vessel dilatation and duration of peak flow change increased with longer duration of cuff occlusion. After 4.5 minutes of occlusion, flow mediated dilatation was mean (SD) 96 (6)% of maximal response and did not increase significantly with longer occlusion times. No significant dilatation occurred after 10 or 20 micrograms of ISDN in any subject. With increasing doses up to 200 micrograms there was an increase in dilatation. Endothelial independent dilatation did not increase significantly with doses of ISDN above 200 micrograms. CONCLUSIONS: Measures of arterial function vary with duration of blood flow occlusion and ISDN dose. Maximum arterial response was reached in all subjects after 4.5 minutes of blood flow occlusion or 200 micrograms of ISDN. Therefore, these variables produce consistent reproducible measures of endothelial function.  相似文献   

15.
目的:探讨高频超声检测高血压患者血管内皮依赖性舒张功能的临床价值。方法:应用高频超产检测高血压患者(25例)和正常血压患者(18例)休息、反应性充血时,舌下含服硝酸甘油后肱动脉内径的变化。结果:内皮依赖性血管舒张功能高血压组较正常血压组明显减弱(7.14±3.20)%∶(13.71%±6.3)%(P〈0.01),高血压组和正常血压组比较血管内皮非依赖性舒张功能无显著性差异(P〉0.05)。结论:高血压患者存在血管内皮依赖性舒张功能失调,高频超声能准确可靠地检测血管内皮依赖性舒张功能。  相似文献   

16.
Blood flow through the brachial and radial artery at different temperatures and during reactive hyperaemia was measured in 23 patients with Raynaud's phenomenon (9 patients with Raynaud's disease, 7 - Raynaud's syndrome with thoracic outlet syndrome (TOS), and 8 - Raynaud's syndrome and scleroderma), and 11 control subjects. Blood flow was determined by an ALVAR pulse-wave Doppler system enabling measurement of vessel diameter and blood flow rate. The measurements suggest that the blood flow through brachial artery reflects the changes of blood flow through the hand immersed in water of different temperatures. Maximum vasoconstriction was the same in all groups of Raynaud's phenomenon. The lowest blood flow at higher temperatures and during reactive hyperaemia was found in patients with scleroderma, whereas in the group of TOS and partly in patients with Raynaud's disease one can suspect only functional changes.  相似文献   

17.
We have assessed early indicators of arterial disease in patients with glycogen storage disease type III (GSD III; McKusick 232400), investigating the plasma lipid and lipoprotein profile and endothelial function. Eleven patients, aged 10–39 years, were recruited together with age-, sex- and smoking status-matched controls. Brachial artery responses were assessed by high-resolution ultrasonographic measurement of the diameter of the brachial artery at baseline, after reactive hyperaemia and in response to sublingual glyceryl trinitrate (GTN).The means of plasma cholesterol (total and HDL and LDL subfractions), triglycerides, apo-A1, apo-B, Lp(a) and the atherogenic index were similar in both groups. Cardiac troponin I was below the lower limits of detection (<0.03g/L) in all subjects. The GSD III patients had similar body mass index (BMI) and brachial artery diameter to the control group (BMI 22.6±5.6 vs 22.3±5kg/m2; brachial artery diameter 3.4±0.5 vs 3±0.7mm). When compared to the baseline diameter, the maximal flow-mediated dilatation of the brachial artery after reactive hyperaemia was 9.3±2.1% (mean±SD) in the GSD III patients and 6.5±3.5% in the control group, a difference of 1.8% (95% CI 0.07% to 5.5%). The maximal dilatation of the brachial artery after GTN administration was 18.3±6.4% in the GSD III patients and 17.9±6.5% in the control group, a difference of 0.4% (95% CI –6.9% to 7.7%.In conclusion, we found no evidence of abnormal plasma lipid and lipoprotein profile or endothelial dysfunction in patients with GSD III. They are unlikely to be at increased risk of premature atherosclerosis.  相似文献   

18.
BACKGROUND: A diminished flow reserve in resistance vessels is a hallmark of hypertensive microvascular disease. Hypertension is associated with structural alterations in the microcirculation and a reduced endothelium-dependent dilation in conduit arteries. Both have been demonstrated to predict future cardiovascular events. OBJECTIVE: We hypothesized that a reduced peripheral flow reserve impairs endothelial function in upstream conduit arteries in patients with arterial hypertension. DESIGN: In 43 hypertensive patients (HT) and 38 normotensive controls (NT) endothelial function of the brachial artery was assessed by measurement of flow-mediated dilatation (FMD), using high-resolution ultrasound. Peripheral flow reserve (FR) was determined via measurements of forearm blood flow at rest and during increments of reactive hyperaemia, using venous occlusion plethysmography. RESULTS: FMD was markedly impaired in HT (3.6 +/- 0.3%) as compared with NT (10.2 +/- 0.3%), whereas maximum brachial artery diameter following endothelium-independent dilatation was similar in both groups. In hypertensive patients FR was significantly reduced (HT, 3.2 versus NT, 6.0) during reactive hyperaemia after 5 min of ischaemia. FR was associated with FMD (r = 0.68, P < 0.01). Multiple stepwise regression analysis identified FR as a strong independent variable determining the extent of FMD (r2 = 0.46, P < 0.01). In HT the dose-response curve of FMD upon stepwise increases of FR was shifted significantly to the right. Normalization of FR improved FMD in HT by more than 60%. CONCLUSIONS: In essential hypertension a reduced FR contributes to the endothelial dysfunction of upstream conduit arteries. These findings may have therapeutic and prognostic implications in patients with arterial hypertension.  相似文献   

19.
Does a glass of red wine improve endothelial function?   总被引:6,自引:0,他引:6  
AIMS: To examine the acute effect of red wine and de-alcoholized red wine on endothelial function. METHODS AND RESULTS: High frequency ultrasound was used to measure blood flow and percentage brachial artery dilatation after reactive hyperaemia induced by forearm cuff occlusion in 12 healthy subjects, less than 40 years of age, without known cardiovascular risk factors. The subjects drank 250 ml of red wine with or without alcohol over 10 min according to a randomized procedure. Brachial artery dilatation was measured again 30 and 60 min after the subjects had finished drinking. The subjects were studied a second time within a week of the first study in a cross-over design. After the red wine with alcohol the resting brachial artery diameter, resting blood flow, heart rate and plasma-ethanol increased significantly. After the de-alcoholized red wine these parameters were unchanged. Flow-mediated dilatation of the brachial artery was significantly higher (P<0.05) after drinking de-alcoholized red wine (5.6+/-3.2%) than after drinking red wine with alcohol (3.6+/-2.2%) and before drinking (3.9+/-2.5%). CONCLUSION: After ingestion of red wine with alcohol the brachial artery dilated and the blood flow increased. These changes were not observed following the de-alcoholized red wine and were thus attributable to ethanol. These haemodynamic changes may have concealed an effect on flow-mediated brachial artery dilatation which did not increase after drinking red wine with alcohol. Flow-mediated dilatation of the brachial artery increased significantly after de-alcoholized red wine and this finding may support the hypothesis that antioxidant qualities of red wine, rather than ethanol in itself, may protect against cardiovascular disease.  相似文献   

20.
目的探讨高血压合并代谢综合征对血管内皮功能及靶器官损害的影响。方法根据代谢综合征的诊断标准将156例高血压病患者分为高血压合并代谢综合征(EH+MS组,n=61例)、高血压非代谢综合征(EH+nonMS组,n=95例)两组,31例健康体检者作为对照组(NC组),用彩色多普勒超声测定反应性充血前后肱动脉内径、血流量及阻力变化,并测定颈动脉粥样斑块及左室重量指数。结果(1)除空腹血糖(FBG)、体重指数(BMI)、甘油三酯(TG)外,EH+MS组的收缩压、舒张压、TC、HDL-C、LDL-C、Fib、年龄、性别比、吸烟习惯等指标与EH+nonMS组均衡可比。(2)内皮依赖性血管舒张功能(FMD%):EH+MS组明显低于EH+nonMS组组及NC[(7.08±3.21)%比(8.18±1.74)%和(10.41±4.52)%,P分别〈0.05和0.01],EH+nonMS组也低于NC组(P〈0.05)。(3)EH+MS组反应性充血后血流量变化率(%)明显低于EH+nonMS组及NC组[(154.19±78.94)%比(196.44±64.22)%和(221.81±89.64)%,P值分别〈0.05和0.01],但EH+nonMS组与NC组间差异无统计学意义。(4)前臂血管扩张能力的高低顺序为NC组(3.21±0.90)〉EH+nonMS组(2.89±0.73)〉EH+MS组(2.58±0.76)。(5)颈动脉粥样斑块发生率分别为17/61(27.9%)、19/95(20.2%)及1/31(3.2%),P〈0.05。(6)左室肥厚发生率从高到低排列分别为EH+MS组(59%)〉EH+nonMS组(37.9%)〉NC组(9.7%)。(7)FMD与年龄、性别、吸烟、收缩压、舒张压、TG、血浆纤维蛋白原有相关性;颈动脉内膜中层厚度与年龄、吸烟、收缩压、舒张压、BMI、TG、血浆纤维蛋白原呈正相关;左室重量指数与年龄、吸烟、SBP、DBP、BMI、TG呈正相关;FMD与颈动脉内膜中层厚度、左室重量指数呈负相关。结论代谢综合征明显加重了高血压病患者血管功能和靶器官损害。  相似文献   

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