Cheung Y F, Brogan P A, Pilla C B, Dillon M J, Redington A N
Department of Cardiology, Great Ormond Street Hospital for Children NHS Trust and Institute of Child Health, London, UK.
Arch Dis Child. 2002 Oct;87(4):348-51. doi: 10.1136/adc.87.4.348.
Polyarteritis nodosa is a necrotising vasculitis of the medium sized and small muscular arteries. The inflammatory and subsequent reparative processes may alter the arterial mechanical properties. The effect of vasculitic damage on arterial distensibility has never been explored however.
To determine the normal values and the effect of childhood vasculitis on arterial distensibility in children and teenagers.
Distensibility of the brachioradial arterial segment was studied using pulse wave velocity (PWV proportional, variant 1/ radical distensibility), in 13 children with polyarteritis nodosa at a median age of 11.8 (range 4.9-16) years. As a control group, 155 healthy schoolchildren (6-18 years, 81 boys) were studied. PWV was assessed using a photoplethysmographic technique; blood pressure was measured by an automatic sphygmomanometer (Dinamap). Data from patients were expressed as z scores adjusted for age and compared to a population mean of 0 by a single sample t test. Determinants of PWV in normal children were assessed by univariate and multivariate linear regression analyses.
Age, height, weight, and systolic blood pressure correlated individually with the brachioradial PWV. Multivariate analysis identified age as the only independent determinant. Ten of the patients were in clinical remission, while three had evidence of disease activity at the time of study. The PWV in the patient group as a whole was significantly greater than those in healthy children (mean z score +0.99). Raised C reactive protein concentration (>2 mg/dl) in the three patients with active disease was associated with a higher PWV when compared to those in remission (z score +2.78 v +0.45). The diastolic blood pressure of the patients was higher than those of the controls (z score +1.04) while the systolic pressure was similar (z score -0.36).
PWV in the brachioradial arterial segment increases gradually during childhood independent of body weight, height, mass, and blood pressure. Increased PWV, and hence decreased distensibility, in this peripheral arterial segment occurs in polyarteritis nodosa and is amplified during acute inflammatory exacerbation.
结节性多动脉炎是一种累及中小肌性动脉的坏死性血管炎。炎症及随后的修复过程可能会改变动脉的力学特性。然而，血管炎性损伤对动脉扩张性的影响尚未得到研究。
确定儿童和青少年动脉扩张性的正常值以及儿童血管炎对其的影响。
采用脉搏波速度（PWV 比例，变体 1/径向扩张性）研究 13 例中位年龄为 11.8 岁（范围 4.9 - 16 岁）的结节性多动脉炎患儿的肱桡动脉段扩张性。作为对照组，研究了 155 名健康学童（6 - 18 岁，81 名男孩）。使用光电容积描记技术评估 PWV；通过自动血压计（Dinamap）测量血压。患者数据以根据年龄调整的 z 评分表示，并通过单样本 t 检验与总体均值 0 进行比较。通过单变量和多变量线性回归分析评估正常儿童 PWV 的决定因素。
年龄、身高、体重和收缩压分别与肱桡动脉 PWV 相关。多变量分析确定年龄是唯一的独立决定因素。10 例患者处于临床缓解期，而 3 例在研究时存在疾病活动证据。患者组整体的 PWV 显著高于健康儿童（平均 z 评分为 +0.99）。与缓解期患者相比，3 例疾病活动患者中升高的 C 反应蛋白浓度（>2mg/dl）与更高的 PWV 相关（z 评分为 +2.78 对 +0.45）。患者的舒张压高于对照组（z 评分为 +1.04），而收缩压相似（z 评分为 -0.36）。
肱桡动脉段的 PWV 在儿童期逐渐增加，与体重、身高、体质和血压无关。在结节性多动脉炎中，该外周动脉段的 PWV 增加，从而扩张性降低，并且在急性炎症加重期间会进一步加剧。
