Abnormal capillary permeability and endothelial dysfunction in hypertension with comorbid Metabolic Syndrome
Abnormal capillary permeability and endothelial dysfunction in hypertension with comorbid Metabolic Syndrome
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DOI：
10.1016/j.atherosclerosis.2003.11.013
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发表时间：
2004-02-01
期刊：
影响因子：
5.3
通讯作者：
Pedrinelli, R
中科院分区：
文献类型：
--
作者：
Dell'Omo, G;Penno, G;Pedrinelli, R
目的：ATP III标准定义的代谢综合征是一系列与胰岛素抵抗相关的危险因素，易发生过早动脉粥样硬化和早期冠状动脉事件。这种负性风险特征是否与内皮功能障碍有关仍有待确定。材料与方法：在24名非糖尿病患者中，评估了白蛋白经毛细血管逃逸率（TERAb），一种毛细血管通透性和全身毛细血管内皮完整性的测量方法，以及前臂血管对动脉内乙酰胆碱（ACH）的舒张，一种一氧化氮（NO）介导的血管功能障碍的指数，根据ATP III标准，患有代谢综合征的无并发症高血压男性（具有至少两种额外特征的高血压，例如高甘油三酯、低HDL、腹部肥胖、空腹或负荷后血糖受损）。12名年龄匹配的瘦型正常高血压患者，血脂和血糖正常，9名血压正常者作为对照。所有患者均进行血脂测定和空腹及OGTT后胰岛素评估; HOMA-IR是胰岛素抵抗的指标。结果：高血压合并代谢综合征患者TERAb升高，而高血压与正常血压对照组无差异。血压（BP）、血脂、血糖、胰岛素水平和HOMA-IR与TERalb无关。代谢性患者对乙酰胆碱的反应选择性减弱，在个体基础上，仅与HDL胆固醇水平相关，与LDL胆固醇、BP、体型、甘油三酯和HOMA-IR值无关。对乙酰胆碱的反应与TERAb之间无相关性。结论：全身毛细血管通透性改变是胰岛素抵抗高血压合并代谢综合征患者的特征。这种缺陷可能促进早期动脉粥样硬化的发展，同时存在着内皮介导的血管舒张功能减弱，表明内皮功能普遍异常。(C)2003爱思唯尔爱尔兰有限公司保留所有权利。
Purpose: Metabolic Syndrome as defined by ATP III criteria, a constellation of risk factors associated with insulin resistance, predisposes to premature atherosclerosis and early coronary events. Whether that negative risk profile is associated with endothelial dysfunction remains to be established. Materials and methods: Transcapillary escape rate of albumin (TERalb), a measure of capillary permeability and integrity of systemic capillary endothelium, and forearm vasodilation to intra-arterial acetylcholine (ACH), an index of nitric oxide (NO)-mediated vasomotor dysfunction, were assessed in 24 non-diabetic, uncomplicated hypertensive men with Metabolic Syndrome according to ATP III criteria (hypertension with at least two additional traits such as high triglycerides, low HDL, abdominal obesity, impaired fasting or post-load plasma glucose). Twelve age-matched lean normal hypertensive patients with normal lipid and glucose profile and nine normotensive subjects were the controls. All patients underwent lipids determination and fasting and post-OGTT insulin assessment; HOMA-IR was the index of insulin resistance. Results: TERalb was higher in hypertensive patients with Metabolic Syndrome, without differences between hypertensive and normotensive controls. Blood pressure (BP), lipids, plasma glucose, insulin levels and HOMA-IR were unrelated to TERalb. Responses to acetylcholine were selectively attenuated in metabolic patients and, on an individual basis, related only to HDL cholesterol levels, independent of LDL cholesterol, BP, body size, triglycerides, and HOMA-IR values. No relationship existed between responses to acetylcholine and TERalb. Conclusions: Altered systemic capillary permeability characterizes insulin-resistant hypertensive patients with Metabolic Syndrome. That defect, which may promote early atherosclerosis development, coexists with blunted endothelial-mediated vasodilation, indicating a pervasive abnormality of endothelial function. (C) 2003 Elsevier Ireland Ltd. All rights reserved.