The primary vascular dysregulation syndrome: implications for eye diseases.
The primary vascular dysregulation syndrome: implications for eye diseases.
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DOI：
10.1186/1878-5085-4-14
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发表时间：
2013-06-07
期刊：
影响因子：
--
通讯作者：
Flammer AJ
中科院分区：
文献类型：
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作者：
Flammer J;Konieczka K;Flammer AJ
血管失调是指血流调节不适应相应组织的需要。我们区分原发性血管失调（PVD，以前称为血管痉挛综合征）和继发性血管失调（SVD）。患有PVD的受试者倾向于四肢冰冷、血压低、口渴感降低、药物敏感性改变、疼痛敏感性增加、睡眠开始时间延长、淋巴细胞中基因表达改变、氧化应激迹象、内皮素-1血浆水平轻微增加、体重指数低以及经常弥漫性和波动性视野缺陷。寒冷、情绪或机械压力以及饥饿都会引起症状。几乎所有的器官，特别是眼睛，都可能受到影响。在患有PVD的受试者中，视网膜血管更僵硬且更不规则，并且神经血管耦合和自动调节能力都降低，而视网膜静脉压通常增加。PVD受试者发生正常眼压性青光眼、视神经间隔室综合征、中心性浆液性脉络膜病变、Susac综合征、视网膜动脉和静脉闭塞和无动脉粥样硬化的前部缺血性神经病变的风险增加。进一步的特征是他们的血脑和血视网膜屏障较弱，视盘出血和活化星形胶质细胞的患病率较高。PVD受试者往往更常遭受耳鸣、肌肉痉挛、有先兆的偏头痛和无症状心肌缺血，并且发生高原反应的风险更大。虽然血管失调的主要原因是血管内皮病变，但也涉及自主神经系统功能障碍。相比之下，SVD发生在其他疾病的背景下，如多发性硬化症，球后神经炎，类风湿性关节炎，纤维肌痛和巨细胞动脉炎。考虑到PVD在人群中的高患病率和潜在的相关病理学，在本文中，作者就如何有效地促进该领域提供了建议，以创建创新的诊断工具来预测病理学并开发更有效的治疗方法。
Vascular dysregulation refers to the regulation of blood flow that is not adapted to the needs of the respective tissue. We distinguish primary vascular dysregulation (PVD, formerly called vasospastic syndrome) and secondary vascular dysregulation (SVD). Subjects with PVD tend to have cold extremities, low blood pressure, reduced feeling of thirst, altered drug sensitivity, increased pain sensitivity, prolonged sleep onset time, altered gene expression in the lymphocytes, signs of oxidative stress, slightly increased endothelin-1 plasma level, low body mass index and often diffuse and fluctuating visual field defects. Coldness, emotional or mechanical stress and starving can provoke symptoms. Virtually all organs, particularly the eye, can be involved. In subjects with PVD, retinal vessels are stiffer and more irregular, and both neurovascular coupling and autoregulation capacity are reduced while retinal venous pressure is often increased. Subjects with PVD have increased risk for normal-tension glaucoma, optic nerve compartment syndrome, central serous choroidopathy, Susac syndrome, retinal artery and vein occlusions and anterior ischaemic neuropathy without atherosclerosis. Further characteristics are their weaker blood–brain and blood-retinal barriers and the higher prevalence of optic disc haemorrhages and activated astrocytes. Subjects with PVD tend to suffer more often from tinnitus, muscle cramps, migraine with aura and silent myocardial ischaemic and are at greater risk for altitude sickness. While the main cause of vascular dysregulation is vascular endotheliopathy, dysfunction of the autonomic nervous system is also involved. In contrast, SVD occurs in the context of other diseases such as multiple sclerosis, retrobulbar neuritis, rheumatoid arthritis, fibromyalgia and giant cell arteritis. Taking into consideration the high prevalence of PVD in the population and potentially linked pathologies, in the current article, the authors provide recommendations on how to effectively promote the field in order to create innovative diagnostic tools to predict the pathology and develop more efficient treatment approaches tailored to the person.