Diffuse endothelial dysfunction is common to ANCA associated systemic vasculitis and polyarteritis nodosa
Diffuse endothelial dysfunction is common to ANCA associated systemic vasculitis and polyarteritis nodosa
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DOI：
10.1136/ard.62.2.162
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发表时间：
2003-02-01
影响因子：
27.4
通讯作者：
Bacon, PA
中科院分区：
文献类型：
--
作者：
Filer, AD;Gardner-Medwin, JM;Bacon, PA
背景：心血管死亡率过高使系统性风湿病复杂化，提示动脉粥样硬化过程加速，这与此类疾病中常见的血管炎症有关。内皮依赖性血管舒张受损是动脉粥样硬化疾病的早期标志。先前的研究表明，这种发生在肱动脉的内皮细胞功能障碍（ECD）可使原发性系统性坏死性血管炎（SNV）复杂化。目的：确定ECD是否发生在更广泛的原发性SNV中，是否局限于大动脉，以及血管炎亚组、ANCA状态或肾脏受累是否影响内皮反应。方法：54名在伯明翰血管炎诊所就诊的患者，包括一系列ANCA和非ANCA相关的原发性血管炎患者，以及一组年龄匹配的对照组。患者随访时间和疾病活动度各不相同。在高分辨率超声评估血流介导的肱动脉血管扩张之前，记录疾病活动性、损伤评分和心血管危险因素。用激光多普勒血流仪测定32例患者和21例对照者对乙酰胆碱的皮肤微血管反应。结果：与对照组相比，与ANCA相关的血管炎和结节性多动脉炎患者的所有原发性SNV亚组均出现ECD。无论炎症性血管炎的血管大小、ANCA关联和滴度或肾脏受累如何，两个血管床都发生了显著损伤。结论：弥漫性内皮功能障碍是动脉粥样硬化疾病的预测因子，在原发性全身性血管炎中广泛存在。不同血管床的累及与靶血管大小或ANCA关联无关，也与局部疾病表达无关。这表明，这是一种全身反应的结果，可能是原发性血管炎的结果，但与局部炎症性血管过程不同。
Background: Excess cardiovascular mortality complicates systemic rheumatic disease, suggesting an accelerated atheromatous process, which it has been proposed relates to the vascular inflammation common in such diseases. Impaired endothelium dependent vasodilatation is an early marker of atheromatous disease. It has previously been shown that such endothelial cell dysfunction (ECD) occurring in the brachial artery can complicate primary systemic necrotising vasculitis (SNV).Objective: To determine if ECD occurs in a wider spectrum of primary SNV, if it is restricted to the major arteries, and whether vasculitis subgroup, ANCA status, or renal involvement influenced the endothelial responses.Methods: Fifty four patients attending the Birmingham vasculitis clinic, including patients with a range of ANCA and non-ANCA associated primary vasculitides, and a group of age matched controls were recruited. The length of patient follow up and disease activity was variable. Disease activity, damage scores, and cardiovascular risk factors were recorded before assessment of flow mediated brachial artery vasodilatation by high resolution ultrasound. Dermal microvascular responses to acetylcholine were also measured in 32 patients and 2 1 controls by laser Doppler flowmetry.Results: ECD was demonstrated in all primary SNV subgroups of patients with ANCA associated vasculitis and in polyarteritis nodosa, compared with controls. Significant impairment occurred in both vascular beds, regardless of vessel size targeted in the inflammatory vasculitis, ANCA association and titre, or renal involvement.Conclusions: Diffuse endothelial dysfunction, a predictor of atherosclerotic disease, is found extensively in primary systemic vasculitis. Involvement of different vascular beds is independent of target vessel size or ANCA association, and is unrelated to local disease expression. It is suggested that this results from a systemic response that may be a consequence of primary vasculitis, but is distinct from the local inflammatory vasculitic process.