老年周围动脉疾病患者上下肢动脉舒张功能对比

背景:血管内皮功能失调是动脉粥样硬化的最初事件,目前评价血管内皮功能的方法较多,但适用于临床推广的方法较少.目的:观察老年周围动脉疾病患者肱动脉及股浅动脉内皮依赖件舒张功能和硝酸甘油介导的非内皮依赖性舒张功能,探讨上下肢动脉舒张功能相关性及特点.设计、时间和地点:非随机化同期对照实验,于2000-10/2002-05在解放军总医院老年心内科完成.对象:选择2000-10/2002-05解放军总医院住院的周围动脉疾病患者33例作为周围动脉疾病组,男27例,女6例.年龄(79±6)岁.均经超声多普勒检查下肢动脉一处以上动脉硬化斑块凸起及管腔狭窄≥50%,且年龄≥60岁.选择同期本院门诊进行健康体检的离退休干部40例作为健康对照组,均为符合中华医学会老年医学学会1995年对健康老人标准的建议.选择木院同期有冠状动脉硬化性心脏病及其危险因素并除外周围动脉疾病的患者30例为心血管危险凶素组.方法:采用无创的方法应用美国通用电器公司生产的Logiq 500型高分辨率彩色多普勒超声诊断系统检测纳入对象的肱动脉及股浅动脉的基础管径,然后阻断该动脉的血流并重新恢复血流后再次检测血管内径,评价其内皮依赖性舒张功能.检测肢体动脉基础内径后,舌下含服硝酸甘油片0.6mg导致血管扩张,以前后两次之差代表该动脉的非内皮依赖性舒张程度.主要观察指标:3组肢体动脉的内皮依赖性舒张功能及非内皮依赖性舒张功能.结果:周围动脉疾病组患者肱动脉的内皮依赖性舒张程度和非内皮依赖性舒张程度与股浅动脉的内皮依赖性舒张程度和非内皮依赖性舒张程度均明显低于健康对照组和心血管危险因素组,差异有显著性意义(t=-11.82～10.91,P<0.05).周围动脉疾病组患者股浅动脉的内皮依赖性舒张程度和非内皮依赖性舒张程度明显低丁肱动脉,差异有显著性意义(t=3.535,3.135,P<0.01);股浅动脉的内皮依赖件舒张程度和非内皮依赖性舒张程度与肱动脉的相关性好(r=0.931 4,0.919 1,P<0.01).结论:股浅动脉的内皮依赖性舒张功能及非内皮依赖性舒张功能能更敏感、更直接地反映老年周围动脉疾病患者的血管反应性.股浅动脉与肱动脉相关性好.

Comparison of endothelium-dependent and -independent dilation between the upper and lower extremity arteries in elderly patients with peripheral artery disease

BACKGROUND: Dysfunction of vascular endothelium is the initial event of atherosclerosis. Although there are many approaches to evaluate the function of vascular endothelium, few are widely used in clinic. OBJECTIVE: To evaluate the brachial and superficial femoral endothelium-dependent dilation, i.e. flow-mediated dilation (FMD) and endothelium-independent dilation, i.e. nitroglycerin-mediated dilation (NMD), of elderly patients with peripheral artery disease (PAD), and to investigate the correlation and characteristics between brachial and superficial femoral FMD and NMD.DESIGN, TIME AND SETTING: Non-randomized concurrent control trial was performed at Department of Geriatric Cardiology, Chinese PLA General Hospital from October 2000 to May 2002.PARTICIPANTS: Thirty-three PAD patients were selected as PAD group, including 27 male and 6 female, aged (79±6)years, who had more than one focus of plaque and arterial stenosis more than 50% in artery of lower extremity by Doppler ultrasound. Accorded with the standard for Health of China Academy of Geriatrics in 1995, 40 healthy retired cadres undergoing health examination were selected as control, including 29 male and 11 female. In addition, 30 patients with coronary arteriosclerotic heart disease or cardiovascular risk factors (excluding age and sex) were selected as risk factor group.METHODS: Using non-invasive approach, high resolution color Doppler ultrasound diagnosis system was applied to detect the basic caliber of upper and lower extremtity arteries in all participants, then the blood flow of the tested artery was blocked and the vascular caliber was detected again after the blood flow was restored to evaluate the endothelium-dependent dilation. The tested subjects took 0.6 mg nitroglycerin to induce vasodilatation after detecting the basic caliber of upper and lower extremtity arteries, then the difference between the two detections was regarded as the endothelium-independent dilation.MAIN OUTCOME MEASURES: The endothelium-dependent dilation and endothelium-independent dilation of upper and lower extremtity arteries.RESULTS: Both FMD and NMD of the brachial artery and the superficial femoral artery in 33 PAD patients were significantly lower than those of healthy controls and non-PAD patients with cardiovascular risk factors (t=-11.82-10.91, P <0.05). In old PAD patients, the superficial femoral FMD and NMD were significantly lower than brachial FMD (t=3.535,3.315, P < 0.01); There was close relationship between the brachial and superficial femoral FMD (r=0.931 4, P < 0.01), so was the NMD (r=0.919 1, P < 0.01).CONCLUSION: The superficial femoral FMD and NMD may reflect the vasoreactivity of PAD patients more directly and sensitively than those of brachial artery. There is close relationship between brachial and superficial femoral arteries.