Comparison between invasive and noninvasive techniques of evaluation of microvascular structural alterations
Comparison between invasive and noninvasive techniques of evaluation of microvascular structural alterations
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DOI：
10.1097/hjh.0000000000001677
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发表时间：
2018-05-01
影响因子：
4.9
通讯作者：
Rizzoni, Damiano
中科院分区：
文献类型：
--
作者：
De Ciuceis, Carolina;Rosei, Claudia Agabiti;Rizzoni, Damiano
背景：人类小阻力动脉形态学特征的评价具有挑战性。金标准方法通常被认为是通过导丝或压力显微肌描记术测量通过局部活检获得的皮下小血管的中膜-管腔比。然而，最近提出的非侵入性技术的视网膜小动脉的评价，特别是，两种方法，扫描激光多普勒血流仪（SLDF）和自适应光学，似乎提供了有用的信息，他们都提供了一个估计的壁腔比（WLR）的视网膜小动脉。此外，基础和总毛细血管密度的非侵入性测量可以通过视频显微镜/毛细血管镜获得。没有直接比较这三种非侵入性技术在同一人群中进行，特别是自适应光学从未验证对micromyography.Methods：在目前的研究中，我们招募了41名对照和患者：12名血压正常的瘦对照，12名原发性高血压瘦患者，9名血压正常的肥胖患者和8名高血压肥胖患者进行择期手术。所有患者在手术期间均接受了皮下脂肪活检。通过钢丝显微肌电描记术评估皮下小阻力动脉结构，并计算中膜与管腔比率。利用SLDF和自适应光学技术获得视网膜小动脉的WLR。结果与结论：自适应光学技术在微血管形态学评价方面明显优于SLDF技术，自适应光学技术测量的WLR与皮下小动脉的M/L相关性更好（r=0.84，P < 0.01）。
Background:The evaluation of the morphological characteristics of small resistance arteries in humans is challenging. The gold standard method is generally considered to be the measurement by wire or pressure micromyography of the media-to-lumen ratio of subcutaneous small vessels obtained by local biopsies. However, noninvasive techniques for the evaluation of retinal arterioles were recently proposed; in particular, two approaches, scanning laser Doppler flowmetry (SLDF) and adaptive optics, seem to provide useful information; both of them provide an estimation of the wall-to-lumen ratio (WLR) of retinal arterioles. Moreover, a noninvasive measurement of basal and total capillary density may be obtained by videomicroscopy/capillaroscopy. No direct comparison of these three noninvasive techniques in the same population was previously performed; in particular, adaptive optics was never validated against micromyography.Methods:In the current study, we enrolled 41 controls and patients: 12 normotensive lean controls, 12 essential hypertensive lean patients, nine normotensive obese patients and eight hypertensive obese patients undergoing elective surgery. All patients underwent a biopsy of subcutaneous fat during surgery. Subcutaneous small resistance artery structure was assessed by wire micromyography and the media-to-lumen ratio was calculated. WLR of retinal arterioles was obtained by SLDF and adaptive optics. Functional (basal) and structural (total) microvascular density was evaluated by capillaroscopy before and after venous congestion.Results and conclusion:Our data suggest that adaptive optics has a substantial advantage over SLDF in terms of evaluation of microvascular morphology, as WLR measured with adaptive optics is more closely correlated with the M/L of subcutaneous small arteries (r=0.84, P