Endothelial dysfunction in peripheral arterial disease is related to increase in plasma markers of inflammation and severity of peripheral circulatory impairment but not to classic risk factors and atherosclerotic burden
Endothelial dysfunction in peripheral arterial disease is related to increase in plasma markers of inflammation and severity of peripheral circulatory impairment but not to classic risk factors and atherosclerotic burden
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DOI：
10.1016/s0741-5214(03)00124-1
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发表时间：
2003-08-01
影响因子：
4.3
通讯作者：
Scopacasa, F
中科院分区：
文献类型：
--
作者：
Brevetti, G;Silvestro, A;Scopacasa, F
目的：我们进行了这项研究，以评估外周动脉疾病（PAD）患者内皮功能障碍的关系，内皮功能障碍与动脉粥样硬化的进展和临床并发症直接相关，变量包括经典危险因素、炎症、外周循环损伤的严重程度和动脉粥样硬化负荷。这项横断面研究包括在学术血管科门诊就诊的患者。研究了88例PAD患者（踝/臂指数[ABI] < 0.90）。对照组为30名年龄、性别相匹配的健康志愿者。主要结果指标为肱动脉血流介导的舒张（FMD）形式的内皮功能、C反应蛋白（CRP）和纤维蛋白原的血浆水平、根据ABI的PAD严重程度和动脉粥样硬化负荷（即一条腿或两个或多个其他部位的动脉粥样硬化）。与FMD大于6.2%的患者相比（即，对照受试者中FMD的第5百分位数），FMD低于6.2%的患者具有相似的经典危险因素患病率，但CRP中位数较高（1.6 vs 6.0 mg/L; P < .01）和纤维蛋白原（200 vs 374 mg/dL; P < .01）。两种炎症标志物与FMD呈负相关（P <0.01）。ABI在FMD大于6.2%的患者中高于内皮功能差的患者（0.72 +/- 0.15 vs 0.62 +/- 16; P <0.01）;动脉粥样硬化负荷无差异。多因素分析显示CRP、纤维蛋白原和ABI与FMD小于6.2%的相关性与经典危险因素无关。在包括CRP、纤维蛋白原和ABI的第二个模型中，所有三个变量与FMD的独立相关性均小于6.2%。结论：炎症和循环障碍的严重程度与PAD的内皮功能障碍的病理生理学有关。
Objective: We undertook this study to evaluate in patients with peripheral arterial disease (PAD) the relationship of endothelial dysfunction, which is directly related to progression and clinical complications of atherosclerosis, with variables including classic risk factors, inflammation, severity of peripheral circulatory impairment, and atherosclerotic burden.Methods. This cross-sectional study included outpatients seen in an academic angiologic unit. Eighty-eight consecutive patients with PAD (ankle/brachial index [ABI] < 0.90) were studied. The control group consisted of 30 age-matched and sex-matched healthy subjects. Main outcome measures were endothelial function in the form of brachial artery flow-mediated dilation (FMD), plasma levels of C-reactive protein (CRP) and fibrinogen, severity of PAD according to ABI, and atherosclerotic burden, ie, atherosclerosis in one leg or in two or more other sites.Results: Compared with patients with FMD greater than 6.2% (ie, 5th percentile of FMD in control subjects), patients with FMD less than 6.2% had a similar prevalence of classic risk factors but higher median levels of CRP (1.6 vs 6.0 mg/L; P < .01) and fibrinogen (200 vs 374 mg/dL; P < .01). The two inflammatory markers were negatively correlated with FMD (P < .01). ABI was higher in patients with FMD greater than 6.2% than in those with worse endothelial function (0.72 +/- 0.15 vs 0.62 +/- 16; P < .01); there was no difference with respect to atherosclerotic burden. Multivariate analysis showed that the association of CRP, fibrinogen, and ABI with FMD less than 6.2% was unrelated to classic risk factors. In a second model, which included CRP, fibrinogen, and ABI, all three variables were independently related to FMD less than 6.2%.Conclusion: Inflammation and severity of circulatory impairment are implicated in the pathophysiology of dysfunctional endothelium in PAD.