硝苯地平对原发性高血压患者血管内皮功能的影响

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。     

超声评价扩张型心肌病患者肱动脉内皮舒张功能

目的应用高频超声评价扩张型心肌病(dilated cardiomyopathy,DCM)患者肱动脉内皮功能。方法应用高频超声测量32例DCM患者和40例健康对照者的基础状态时、反应性充血后、舌下含服硝酸甘油后的肱动脉内径,计算反应性充血和含服硝酸甘油后肱动脉内径变化的百分率。结果DCM患者反应性充血所致的肱动脉内径百分变化率[(4.0±3.5)%]明显低于正常人[(13.2±3.9)%,P<0.05],DCM患者含服硝酸甘油所致的肱动脉内径变化的百分率[(27.8±9.2)%]和健康对照者[(28.5±8.9)%,P>0.05]差别无显著统计学意义。结论DCM患者肱动脉内皮舒张功能受损。     

彩色多普勒超声对糖尿病血管内皮功能的评价

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.     

阻塞性睡眠呼吸暂停低通气综合征患者的血管内皮舒张功能

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。     

彩色多普勒超声对糖尿病血管内皮功能的评价

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。     

老年心力衰竭患者血管内皮舒张功能的变化及临床意义

本研究应用高分辨力超声测量肱动脉反应性充血前后内径变化反映血管内皮功能,从超声下血流介导肱动脉舒张功能评价慢性充血性心力衰竭(CHF)患者血管内皮功能变化,探讨内皮功能障碍与CHF严重程度的关系,为临床治疗CHF探索新的途径.     

高频超声评价高血压患者血管内皮功能的研究

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。     

高分辨率超声在检测糖尿病患者早期血管内皮功能中的应用

目的评价高分辨率超声在检测初发糖尿病患者的动脉内-中膜厚度(IMT)和血管内皮功能中的应用价值。方法测定22例老年初发糖尿病患者、142例非老年初发糖尿病患者及同期20例老年健康者和20例非老年健康者的颈动脉、髂动脉、股动脉的内-中膜厚度,肱动脉反应性充血前后及舌下含服硝酸甘油前后内径的变化,并进行统计学分析。结果老年糖尿病组反应性充血时肱动脉内径变化率为(10．03±6．39)％,较老年对照组(15．87±4．79)％下降,两组比较差异有统计学意义(P<0．05);老年糖尿病组各段动脉IMT测值较老年对照组增厚(P<0．05);非老年糖尿病组反应性充血时肱动脉内径变化率为(13．38±5．94)％,较非老年对照组(16．91±5．97)％下降,两组比较差异有统计学意义(P<0．05);硝酸甘油介导的肱动脉内径变化百分率各组间比较,差异无统计学意义(P>0．05)。结论高分辨率超声检查可及早发现糖尿病患者血管内皮功能受损情况,对于糖尿病大血管并发症的早期发现及治疗效果的评价具有应用价值。     

应用超声血管反应性充血法评价血管内皮功能

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。     

福辛普利对老年高血压患者内皮依赖性血管舒张功能的影响

目的探讨福辛普利对老年高血压患者内皮依赖性血管舒张功能(FMD)的影响及机制。方法应用高频彩色多普勒超声检测仪对68例老年高血压患者进行FMD的无创检查,并观察福辛普利治疗前后患者FMD的变化。结果福辛普利治疗后老年高血压患者血管内径和硝酸甘油诱发的肱动脉内径变化率与治疗前无明显差异(P>0.05),但反应性充血诱发的肱动脉内径变化率较治疗前明显增加(P<0.05)。结论老年高血压患者出现明显FMD障碍,福辛普利治疗可改善老年高血压患者血管内皮功能。     

Evaluation by high-resolution ultrasonography of endothelial function in brachial artery after Kawasaki disease and the effects of intravenous administration of vitamin C.

Previous studies in patients with a history of Kawasaki disease (KD) have focused on the endothelial function of the coronary arteries and that of the systemic arteries is not fully understood. Furthermore, the effect of vitamin C on systemic vascular endothelial function after KD has not yet been elucidated. In the present study, 39 patients (age, 7.1 +/- 2.7 years) at 1-10 years after acute KD were compared with 17 matched healthy subjects (7.0 +/- 3.1 years). High-resolution ultrasonography was used to analyze brachial artery responses to reactive hyperemia (with increased flow causing endothelium-dependent dilation) and sublingual nitroglycerin (causing endothelium-independent dilation) after KD, and to investigate whether the acute administration of vitamin C can restore systemic endothelial dysfunction. The percent change in diameter of the brachial artery induced by reactive hyperemia in the patients with a history of KD (6.2 +/- 3.9%) was significantly less than that in the control group (14.1 +/- 6.8%, p < 0.0001). No significant difference could be found in the percent change in diameter induced by sublingual nitroglycerin between the controls (33.2 +/- 13.7%) and the patients (30.6 +/- 9.2%, p = 0.49). There was no significant difference in percent change in diameter of the brachial artery induced by reactive hyperemia between the patients who received gamma globulin (6.0 +/- 4.0) and those who did not (7.9 +/- 3.3, p = 0.33). Intravenous infusion of vitamin C significantly increased the percent change in diameter of the brachial artery induced by reactive hyperemia in 19 patients with history of KD (6.6 +/- 3.5% to 13.0 +/- 5.5%, p < 0.0001). After placebo administration in 20 patients with history of KD there was no significant increase in the percent change in the diameter of the brachial artery induced by reactive hyperemia (6.5 +/- 4.5% to 7.3 +/- 4.9%, p = 0.20). The decreased percent change in the diameter of the brachial artery induced by reactive hyperemia in patients with a history of KD compared with the healthy children indicates that systemic endothelial dysfunction exists after KD. Although it is not influenced by early treatment with high-dose gamma globulin in the acute stage of KD, systemic vascular endothelial function can be restored by acute intravenous administration of vitamin C.     

培垛普利对冠心病患者经皮冠状动脉介入术后肱动脉内皮功能障碍的影响

目的探讨培垛普利对经皮冠状动脉介入（PCI）操作所诱发的肱动脉内皮功能不全的影响。方法实行PCI的冠心病患者62例,随机分为2组,培垛普利组31例,对照组31例,应用高频超声探头分别测量2组PCI术前及术后的肱动脉基础内径、反应性充血内径、含服硝酸甘油后内径,计算肱动脉血流介导的舒张反应（FMD）,并运用多普勒技术测定血流速度峰值,最后比较2组间及组内上述参数的差异。超声测量于PCI术前2h和术后30min内完成。结果培垛普利组的FMD明显改善[（5．9±0．3）％术前vs（7．7±0．4）％术后PCI,P〈0．0013,而对照组明显恶化[（6．0±0．5）％术前vs（4．8±0．6）％术后PCI,P〈0．0013。两组硝酸甘油介导的血管舒张反应及反应性充血血流速度峰值均无明显变化。结论培垛普利可改善PCI介导的肱动脉内皮功能不全。     

Endothelial function, carotid artery intima-media thickness, epicardial adipose tissue, and left ventricular mass and function in growth hormone-deficient adolescents: apparent effects of growth hormone treatment on these parameters

OBJECTIVE: The purpose of this study was to determine whether GH-deficient (GHD) adolescents have abnormalities of cardiac and vascular function detectable during the teenage years. DESIGN/METHODS: Ten GHD children on GH treatment with a chronological age (CA) of 14.6 +/- 1.7 yr and 12 untreated GHD adolescents with a CA of 15.0 +/- 3.0 yr were studied. Cardiac mass and function, carotid artery intima-media thickness, flow-mediated endothelium-dependent vasodilation (percent change from baseline diameter during hyperemia), and hyperemia-induced blood flow increase of the brachial artery (percent change from baseline) and epicardial adipose tissue were evaluated by echocardiography. Fourteen healthy adolescents served as controls. RESULTS: Untreated GHD adolescents present with a reduced left ventricular mass when compared with controls (P < 0.05) and a lower flow-mediated endothelium-dependent increase in the diameter of the brachial artery during hyperemia than both controls and treated GHD subjects (P < 0.02), whereas their epicardial adipose tissue is significantly higher than that of healthy controls (P < 0.02). Interventricular septum thickness, posterior wall thickness, left ventricular ejection fraction, and carotid artery intima-media thickness were similar in all three groups. Hyperemia-induced blood flow increase was greater in treated GHD adolescents than both untreated subjects and controls (P < 0.001). Body mass index correlated positively with epicardial adipose tissue in all three groups and with carotid intima-media thickness in treated and untreated GHD adolescents. CONCLUSIONS: GHD adolescents have a reduced left ventricular mass and vascular abnormalities manifested by lower flow-mediated endothelium-dependent vasodilation. These findings together with an increase in epicardial adipose tissue, a good indicator of abdominal/visceral fat, may contribute to an increased cardiovascular risk in the long term. An improvement in endothelial function and a reduction in arterial stiffness appear to occur after GH replacement.     

Acute reversal of endothelial dysfunction in the elderly after antioxidant consumption

Aging is associated with a pro-oxidant state and a decline in endothelial function. Whether acute, enteral antioxidant treatment can reverse this decrement in vascular function is not well known. Flow-mediated vasodilation and reactive hyperemia were evaluated after consumption of either placebo or an oral antioxidant cocktail (vitamin C, 1000 mg; vitamin E, 600 IU; α-lipoic acid, 600 mg) in 87 healthy volunteers (42 young: 25±1 years; 45 older: 71±1 years) using a double-blind, crossover design. Blood velocity and brachial artery diameter (ultrasound Doppler) were assessed before and after 5-minute forearm circulatory arrest. Serum markers of lipid peroxidation, total antioxidant capacity, endogenous antioxidant activity, and vitamin C were assayed, and plasma nitrate, nitrite, and 3-nitrotyrosine were determined. In the placebo trial, an age-related reduction in brachial artery vasodilation was evident (young: 7.4±0.6%; older: 5.2±0.4%). After antioxidant consumption, flow-mediated vasodilation improved in older subjects (placebo: 5.2±0.4%; antioxidant: 8.2±0.6%) but declined in the young (placebo: 7.4±0.6%; antioxidant: 5.8±0.6%). Reactive hyperemia was reduced with age, but antioxidant administration did not alter the response in either group. Together, these data demonstrate that antioxidant consumption acutely restores endothelial function in the elderly while disrupting normal endothelium-dependent vasodilation in the young and suggest that this age-related impairment is attributed, at least in part, to free radicals.     

Non invasive evaluation of endothelial function in patients with Anderson-Fabry disease.

AIM: Fabry's disease is an X-linked recessive abnormality of glycosphingolipid metabolism. Increased levels of endothelial prothrombotic factors have recently been demonstrated in Fabry's disease, whereas endothelial function has not been studied using high resolution ultrasound. METHODS: We enrolled 6 patients (4 male, 2 female; mean age, 37 years) and 12 sex matched control subjects (mean age, 37 years). Patients' exclusion criteria included a prior history of cardiac disease, diabetes and treated or untreated hypertension. Patients underwent: anamnesis, physical examination, EKG, 2-dimensional echocardiography with tissue Doppler, measurement of body weight and height, blood pressure. Biochemistry variables were also considered: fasting blood sugar, total cholesterol, HDL-C, LDL-C, triglycerides, fibrinogen, C reactive protein and homocysteine. Using high resolution ultrasound, we assessed the brachial vasodilator response to reactive hyperemia (endothelium-dependent) and sublingual nitroglycerin (NTG) (endothelium-independent). Flow-mediated dilatation (FMD) was expressed as percentage change in post-stimulus diameter in comparison with the baseline. RESULTS: In baseline condition, there was no significant difference between patients and controls in the brachial artery diameter (3.5+/-0.55 vs 3.1+/-0.4). After reactive hyperemia, the FMD change was significantly higher in controls than in patients (16.5+/-6.3% vs 9.3+/-6.2%, P<0.05). After NTG, endothelium-independent vasodilation did not show a significant difference between cases and controls (15+/-7.7% vs 13.8+/-7.1%). CONCLUSIONS: Our study demonstrated the presence of endothelial dysfunction in patients with Fabry's disease in comparison to controls. We hypothesized that endothelial dysfunction may contribute to the pathogenesis of ischemic events in patients with Fabry's disease.     

Relation between digital peripheral arterial tonometry and brachial artery ultrasound measures of vascular function in patients with coronary artery disease and in healthy volunteers

Digital peripheral arterial tonometry (PAT) is an emerging, noninvasive method to assess vascular function. The physiology underlying this phenotype, however, remains unclear. Therefore, we evaluated the relation between digital PAT and established brachial artery ultrasound measures of vascular function under basal conditions and after reactive hyperemia. Using a cross-sectional study design, digital PAT and brachial artery ultrasonography with pulsed wave Doppler were simultaneously completed at baseline and after reactive hyperemia in both those with established coronary artery disease (n = 99) and healthy volunteers with low cardiovascular disease risk (n = 40). Under basal conditions, the digital pulse volume amplitude demonstrated a significant positive correlation with the brachial artery velocity-time integral that was independent of the arterial diameter, in both the healthy volunteer (r(s) = 0.64, p <0.001) and coronary artery disease (r(s) = 0.63, p <0.001) cohorts. Similar positive relations were observed with the baseline brachial artery blood flow velocity and blood flow. In contrast, no relation between the reactive hyperemia-evoked digital PAT ratio and either brachial artery flow-mediated dilation or shear stress was observed in either cohort (p = NS). In conclusion, these findings demonstrate that the digital PAT measures of vascular function more closely reflect basal blood flow in the brachial artery than reactive hyperemia-induced changes in the arterial diameter or flow velocity, and the presence of vascular disease does not modify the physiology underlying the digital PAT phenotype.     

Long-term effect of combined vitamins E and C on coronary and peripheral endothelial function

OBJECTIVES: We tested whether long-term administration of antioxidant vitamins C and E improves coronary and brachial artery endothelial function in patients with coronary artery disease (CAD). BACKGROUND: Endothelial function is a sensitive indicator of vascular health. Oxidant stress and oxidized low-density lipoprotein (LDL) impair endothelial function by reducing nitric oxide bioavailability in the artery wall. METHODS: We randomly assigned 30 subjects with CAD to combined vitamin E (800 IU per day) and C (1000 mg per day) or to placebos in a double-blind trial. Coronary artery endothelial function was measured as the change in coronary artery diameter to acetylcholine infusions (n = 18 patients), and brachial artery endothelial function was assessed by flow-mediated dilation (n = 25 patients) at baseline and six months. Plasma markers of oxidant stress (oxidized LDL and autoantibodies) were also measured. RESULTS: Plasma alpha-tocopherol (p < 0.001) and ascorbic acid (p < 0.02) increased with active therapy. Compared to placebo, there was no improvement in coronary and brachial endothelial vasomotor function over six months. Although vitamins C and E tended to reduce F2-isoprostanes (p = 0.065), they failed to alter oxidized LDL or autoantibodies to oxidized LDL. CONCLUSIONS: Long-term oral vitamins C and E do not improve key mechanisms in the biology of atherosclerosis or endothelial dysfunction, or reduce LDL oxidation in vivo.