Local shear stress and brachial artery functions in end-stage renal disease
Local shear stress and brachial artery functions in end-stage renal disease
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DOI：
10.1681/asn.2006040400
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发表时间：
2007-02-01
影响因子：
13.6
通讯作者：
London, Gerard M.
中科院分区：
文献类型：
--
作者：
Verbeke, Francis H.;Agharazii, Mohsen;London, Gerard M.
生理性层流剪切应力（SS）对正常血管结构和功能至关重要。由于贫血相关的低全血粘度（WBV），SS可以降低ESRD患者，并可能与动脉功能的改变。在44例ESRD患者和25例对照受试者中，评价了肱动脉（BA）顺应性和BA直径变化（血流介导的扩张[FMD]）对暖手诱导充血期间局部剪切率和SS变化的反应。ESRD组BA血流与对照组相似，SS低于对照组（P < 0.001），血流切变率低于对照组（P <0.01），WBV低于对照组（P < 0.0001）。在对照组中，SS与动脉直径呈正相关（生理相关）（P < 0.001）。相反，在ESRD患者中，较大的动脉直径与低SS（P < 0.05）和动脉壁弹性模量增加（P < 0.001）相关。贫血相关的低WBV导致低剪切速率，进一步促进SS降低。这些异常与内皮机械刺激的血管舒张反应降低有关。与对照组相比，ESRD患者的BA顺应性和FMD对暖手诱导的SS增加的反应较低（P < 0.01），而他们对硝酸甘油的BA直径反应没有差异。贫血纠正后WBV和SS的长期增加改善了FMD（P < 0.01）和BA顺应性（P < 0.05），并提高了动脉壁对机械刺激的敏感性。贫血导致的维持性低SS可能在ESRD患者的动脉功能障碍中起间接作用。
Physiologic laminar shear stress (SS) is crucial for normal vascular structure and function. As a result of anemia-related lower whole-blood viscosity (WBV), SS could be reduced in patients with ESRD and might be associated with arterial functional alterations. In 44 patients with ESRD and 25 control subjects, brachial artery (BA) compliance and BA diameter changes (flow-mediated dilation [FMD[) were evaluated in response to local shear rate and SS changes during hand warming-induced hyperemia. Patients with ESRD and control subjects had similar BA blood flow, but SS was lower in patients with ESRD (P < 0.001), with lower shear rate (P < 0.01) and lower WBV (P < 0.0001). In control subjects, SS was positively (and physiologically) correlated with arterial diameter (P < 0.001). In contrast, in patients with ESRD, larger arterial diameter was associated with low SS (P < 0.05) and increased arterial wall elastic modulus (P < 0.001). Anemia-associated low WBV aggravates low shear rate, further contributing to SS reduction. These abnormalities were associated with decreased vasodilating response to endothelial mechanical stimulation. Compared with control subjects, BA compliance and FMD increases in response to hand warming-induced increased SS were lower in ESRD patients (P < 0.01), whereas their BA diameter response to glyceryl trinitrate did not differ. The long-term WBV and SS increases after anemia correction improved FMD (P < 0.01) and BA compliance (P < 0.05) and heightened arterial wall sensitivity to mechanical stimulation. Maintenance low SS as a result of anemia could play an indirect role in arterial dysfunction in patients with ESRD.