Endothelial dysfunction in inflammatory bowel diseases: Pathogenesis, assessment and implications
Endothelial dysfunction in inflammatory bowel diseases: Pathogenesis, assessment and implications
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DOI：
10.3748/wjg.v22.i3.1067
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发表时间：
2016-01-21
影响因子：
4.3
通讯作者：
Owczarek, Danuta
中科院分区：
文献类型：
--
作者：
Cibor, Dorota;Domagala-Rodacka, Renata;Owczarek, Danuta
内皮功能障碍被认为是炎症性肠病（IBD）的病因之一。炎症过程导致血管内皮功能和结构的变化。观察到白细胞粘附性和白细胞血透增加，以及血管平滑肌张力和促凝血活性增加。血管内皮的结构变化还包括毛细血管和小静脉的重塑以及内皮细胞的增殖。炎症区域的缺氧通过血管内皮生长因子、成纤维细胞生长因子和肿瘤坏死因子-α的上调刺激血管生成。炎症介质还会改变淋巴管功能并损害淋巴液流动，加剧组织水肿以及死细胞和细菌的积累。内皮功能障碍可通过使用两种主要方法来诊断：物理方法和生化方法。物理方法基于对大动脉血管舒张的评估，以响应流量增加和受体刺激。血流介导的血管舒张（FMD）是应用最广泛的方法；然而，它在检测内皮功能的早期变化方面不太敏感。大多数研究表明 IBD 患者的 FMD 有所降低，但颈动脉内膜中层厚度没有变化。检测内皮功能障碍的生化方法基于对正常内皮和受损内皮产生的化合物的合成的评估。内皮功能障碍被认为是普通人群动脉粥样硬化发病机制的第一步。在IBD患者中，心血管疾病的风险存在争议。需要进行大型前瞻性研究来确定特定药物或饮食元素在内皮功能障碍中的作用，并确定心血管疾病的真正风险。
Endothelial dysfunction is considered one of the etiological factors of inflammatory bowel disease (IBD). An inflammatory process leads to functional and structural changes in the vascular endothelium. An increase of leukocyte adhesiveness and leukocyte diapedesis, as well as an increased vascular smooth muscle tone and procoagulant activity is observed. Structural changes of the vascular endothelium comprise as well capillary and venule remodeling and proliferation of endothelial cells. Hypoxia in the inflammatory area stimulates angiogenesis by up-regulation of vascular endothelial growth factor, fibroblast growth factor and tumor necrosis factor-alpha. Inflammatory mediators also alter the lymphatic vessel function and impair lymph flow, exacerbating tissue edema and accumulation of dead cells and bacteria. The endothelial dysfunction might be diagnosed by the use of two main methods: physical and biochemical. Physical methods are based on the assessment of large arteries vasodilatation in response to an increased flow and receptors stimulation. Flow-mediated vasodilatation (FMD) is the method that is the most widely used; however, it is less sensitive in detecting early changes of the endothelium function. Most of the studies demonstrated a decrease of FMD in IBD patients but no changes in the carotic intima-media thickness. Biochemical methods of detecting the endothelial dysfunction are based on the assessment of the synthesis of compounds produced both by the normal and damaged endothelium. The endothelial dysfunction is considered an initial step in the pathogenesis of atherosclerosis in the general population. In IBD patients, the risk of cardiovascular diseases is controversial. Large, prospective studies are needed to establish the role of particular medications or dietary elements in the endothelial dysfunction as well to determine the real risk of cardiovascular diseases.