Assessment of Vascular Function in Patients With Chronic Kidney Disease
Assessment of Vascular Function in Patients With Chronic Kidney Disease
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DOI：
10.3791/51478
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发表时间：
2014-06-01
影响因子：
1.2
通讯作者：
Jalal, Diana
中科院分区：
文献类型：
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作者：
Jablonski, Kristen L.;Decker, Emily;Jalal, Diana
与普通人群相比，慢性肾脏病（CKD）患者患心血管疾病（CVD）的风险显著增加，这只能部分解释为传统的CVD风险因素。血管功能障碍是一种重要的非传统风险因素，其特征为血管内皮功能障碍（最常评估为内皮依赖性舒张功能受损[EDD]）和大弹性动脉硬化。虽然存在各种技术来评估EDD和大弹性动脉僵硬度，但最常用的分别是肱动脉血流介导的扩张（FMDBA）和主动脉脉搏波速度（aPWV）。这两种血管功能障碍的无创性指标都是有或无肾脏疾病患者未来心血管事件的独立预测因子。CKD患者表现出FMDBA受损和aPWV增加。虽然在CKD中血管功能障碍发展的确切机制尚不完全清楚，但氧化应激增加和随后的一氧化氮（NO）生物利用度降低是重要的贡献者。氧化应激的细胞变化可以通过从肘前静脉收集血管内皮细胞并使用免疫荧光测量氧化应激标志物的蛋白质表达来评估。我们在这里提供了这些方法来测量FMDBA，aPWV，和血管内皮细胞蛋白表达的讨论。
Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this is only partially explained by traditional CVD risk factors. Vascular dysfunction is an important non-traditional risk factor, characterized by vascular endothelial dysfunction (most commonly assessed as impaired endothelium-dependent dilation [EDD]) and stiffening of the large elastic arteries. While various techniques exist to assess EDD and large elastic artery stiffness, the most commonly used are brachial artery flow-mediated dilation (FMDBA) and aortic pulse-wave velocity (aPWV), respectively. Both of these noninvasive measures of vascular dysfunction are independent predictors of future cardiovascular events in patients with and without kidney disease. Patients with CKD demonstrate both impaired FMDBA, and increased aPWV. While the exact mechanisms by which vascular dysfunction develops in CKD are incompletely understood, increased oxidative stress and a subsequent reduction in nitric oxide (NO) bioavailability are important contributors. Cellular changes in oxidative stress can be assessed by collecting vascular endothelial cells from the antecubital vein and measuring protein expression of markers of oxidative stress using immunofluorescence. We provide here a discussion of these methods to measure FMDBA, aPWV, and vascular endothelial cell protein expression.