Flow-mediated vasodilation and distensibility of the brachial artery in renal allograft recipients
Flow-mediated vasodilation and distensibility of the brachial artery in renal allograft recipients
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DOI：
10.1046/j.1523-1755.1999.0550031104.x
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发表时间：
1999-03-01
影响因子：
19.6
通讯作者：
Barenbrock, M
中科院分区：
文献类型：
--
作者：
Hausberg, M;Kisters, K;Barenbrock, M
背景资料。肾移植受者常可观察到大动脉功能和结构的改变。然而，在这一人群中，内皮功能尚未被评估。血流介导的血管扩张是血管内皮功能的有用指标。我们使用高分辨率超声和M型血管壁运动的多普勒频率分析测量了静息状态下肱动脉的内径和扩张性。此后，测量了16例接受环孢素治疗的同种异体肾移植受者和16例年龄和性别比例相近的正常对照组在反应性充血期间(前臂阻断4分钟后)的肱动脉内径的变化。测定硝酸甘油介导的血管扩张，以评估内皮非依赖性血管扩张。用全自动血压计测量肱动脉血压，用脉冲多普勒估测肱动脉血流量。肾移植受者的扩张性降低(5.31±0.74vs.9.10+/-0.94x10(-3)/kpa，P=0.003)，而静息状态下的肱动脉内径较大(3.25±0.14vs.3.25±0.14 mm，P<；0.001)。肾移植受者血流介导的血管扩张显著减少(0.13±0.08vs.0.60±0.08 mm或3+/-2vs.19+/-3%，P均<0.001)。然而，硝酸甘油介导的血管扩张在肾移植受者和对照组中相似(0.76+/-0.10比0.77+/-)。0.09 mm，NS，或19+/-3对22+/-2%，NS)。两组患者在静息状态和反应性充血时的肱动脉血流量无显著差异。在校正了血清胆固醇、肌酐、甲状旁腺激素浓度、舒张末内径和血压水平后，肾移植受者的血流介导的血管扩张和扩张性的损害仍然显著，在8名未接受环孢素治疗的肾移植受者中也存在。在两组患者中，血流介导的血管扩张与扩张性无关。结果显示，肾移植受者内皮功能受损，臂动脉扩张性降低。血流介导的血管扩张和扩张性的损害不能归因于臂动脉扩张剂能力的减弱，因为肾移植受者保留了非内皮依赖性的血管扩张。
Background. Alterations of large artery function and structure are frequently observed in renal allograft recipients. However, endothelial function has not yet been assessed in this population.Methods. Flow-mediated vasodilation is a useful index of endothelial function. We measured the diameter and distensibility of the brachial artery at rest using high-resolution ultrasound and Doppler frequency analysis of vessel wall movements in the M mode. Thereafter, changes in brachial artery diameter were measured during reactive hyperemia (after 4 min of forearm occlusion) in 16 cyclosporine-treated renal allograft recipients and 16 normal controls of similar age and sex ratio. Nitroglycerin-mediated vasodilation was measured to assess endothelium-independent vasodilation. Brachial artery blood pressure was measured using an automatic sphygmomanometer, and brachial artery flow was estimated using pulsed Doppler.Results. Distensibility was reduced in renal allograft recipients (5.31 +/- 0.74 vs. 9.10 +/- 0.94 x 10(-3)/kPa, P = 0.003, mean +/- SEM), while the brachial artery diameter at rest was higher (4.13 +/- 0.14 vs. 3.25 +/- 0.14 mm, P < 0.001). Flow-mediated vasodilation was significantly reduced in renal allograft recipients (0.13 +/- 0.08 vs. 0.60 +/- 0.08 mm or 3 +/- 2 vs. 19 +/- 3%, both P < 0.001). However, nitroglycerin-mediated vasodilation was similar in renal allograft recipients and controls (0.76 +/- 0.10 vs. 0.77 +/-. 0.09 mm, NS, or 19 +/- 3 vs. 22 +/- 2%, NS). There were no significant differences in brachial artery flow at rest and during reactive hyperemia between both groups. The impairments of flow-mediated vasodilation and distensibility in renal allograft recipients remained significant after correction for serum cholesterol, creatinine, parathyroid hormone concentrations, end-diastolic diameter, as well as blood pressure levels, and were also present in eight renal allograft recipients not treated with cyclosporine. Flow-mediated vasodilation was not related to distensibility in either group.Conclusions. The results show impaired endothelial function and reduced brachial artery distensibility in renal allograft recipients. The impairments of flow-mediated vasodilation and distensibility are not attributable to a diminished brachial artery vasodilator capacity, because endothelium-independent vasodilation was preserved in renal allograft recipients.