Yataco A R, Corretti M C, Gardner A W, Womack C J, Katzel L I
Department of Medicine, University of Maryland School of Medicine and Baltimore Veterans Affairs Medical Center, 21201, USA.
Am J Cardiol. 1999 Mar 1;83(5):754-8. doi: 10.1016/s0002-9149(98)00984-9.
Peripheral arterial disease (PAD) is a major cause of morbidity and mortality. Endothelium-dependent vasoreactivity, which is advocated as a measure of vascular health, is impaired in persons with cardiac risk factors and coronary artery disease. Few studies have examined the degree of endothelial dysfunction in patients with PAD. Using high-resolution external vascular ultrasound, we measured brachial artery diameter and flow at rest, and in response to reactive hyperemia (flow-mediated dilation) in 50 older patients (age 69 +/- 1 year) with PAD (ankle-to-brachial artery index of 0.67 +/- 0.03), and 50 age-matched non-PAD patients. Coronary artery disease was more prevalent in PAD than in non-PAD patients (40% vs 4%, p <0.001). Systolic blood pressure (153 +/- 4 vs 141 +/- 3 mm Hg, p <0.01), fasting glucose (129 +/- 6 vs 109 +/- 5 mg/dl, p <0.001), and pack-years smoked (54 +/- 7 vs 25 +/- 3, p <0.01) were higher in the PAD than in non-PAD patients. There were no differences in baseline brachial artery diameter, blood velocity, or flow between the 2 groups. However, the 1-minute postocclusion percent change in diameter (6.5 +/- 0.7% vs 9.8 +/- 0.7%, p <0.001) and the change in diameter (0.22 +/- 0.02 vs 0.33 +/- 0.02 mm, p <0.001) were lower in PAD than in non-PAD patients, suggesting impaired endothelium-dependent dilation. The postocclusion hyperemic velocity and blood flow were also lower in PAD than in non-PAD patients. In multiple regression analyses the low-density lipoprotein-to-high-density lipoprotein cholesterol ratio, elevated fasting glucose, and high systolic blood pressure were independent predictors of percent change in brachial artery diameter (r2 = 0.37, p <0.001). Thus, older patients with PAD had impaired endothelial dependent vasodilation compared with controls that was associated with the presence of cardiac risk factors. The effect of cardiac risk factor intervention on endothelial function in patients with PAD remains to be determined.
外周动脉疾病（PAD）是发病和死亡的主要原因。内皮依赖性血管反应性被认为是血管健康的一项指标，在有心脏危险因素和冠状动脉疾病的人群中受损。很少有研究检测PAD患者的内皮功能障碍程度。我们使用高分辨率外部血管超声，测量了50例老年PAD患者（年龄69±1岁，踝臂指数为0.67±0.03）和50例年龄匹配的非PAD患者静息时以及反应性充血（血流介导的扩张）时的肱动脉直径和血流。冠状动脉疾病在PAD患者中比在非PAD患者中更常见（40%对4%，p<0.001）。PAD患者的收缩压（153±4对141±3 mmHg，p<0.01）、空腹血糖（129±6对109±5 mg/dl，p<0.001）和吸烟包年数（54±7对25±3，p<0.01）均高于非PAD患者。两组之间的基线肱动脉直径、血流速度或血流量无差异。然而，PAD患者阻塞后1分钟直径的百分比变化（6.5±0.7%对9.8±0.7%，p<0.001）和直径变化（0.22±0.02对0.33±0.02 mm，p<0.001）低于非PAD患者，提示内皮依赖性扩张受损。PAD患者阻塞后充血速度和血流量也低于非PAD患者。在多元回归分析中，低密度脂蛋白与高密度脂蛋白胆固醇比值、空腹血糖升高和高收缩压是肱动脉直径百分比变化的独立预测因素（r2 = 0.37，p<0.001）。因此，与对照组相比，老年PAD患者的内皮依赖性血管舒张受损，这与心脏危险因素的存在有关。心脏危险因素干预对PAD患者内皮功能的影响仍有待确定。
