Cheng K-S, Tiwari A, Boutin A, Denton C P, Black C M, Morris R, Hamilton G, Seifalian A M
University Department of Surgery, University College London, London, UK.
Rheumatology (Oxford). 2003 Nov;42(11):1299-305. doi: 10.1093/rheumatology/keg371. Epub 2003 May 30.
Large-vessel arterial disease is increasingly recognized as a major cause of morbidity in autoimmune rheumatic disorders. Recent evidence suggests that scleroderma (systemic sclerosis, SSc) may be linked to altered fibrillin-1 metabolism associated with a defect in chromosome 15q. If this is the case, we may expect to see changes in the arterial wall mechanics of large vessels not clinically involved in the disease process. We undertook a study to determine whether the biomechanical properties and intima-media thickness (IMT) of the elastic carotid artery and the muscular femoral artery are altered in subjects with limited (lcSSc) and diffuse (dcSSc) cutaneous SSc.
Measurements of carotid and femoral wall mechanics were made in 33 patients with lcSSc, 19 patients with dcSSc and 21 control subjects, using a duplex scanner coupled to a Wall Track system. Their age, gender, body mass index, heart rate, systolic and diastolic blood pressures, presumed cardiovascular load, and plasma creatinine, fasting cholesterol, triglyceride and glucose concentrations were also measured.
There was a progressive and significant reduction (P < 0.001) in the elastic properties of the carotid artery from the control group (compliance, 16.24 +/- 4.39 %mmHg(-1) x 10(-2)) to the lcSSc group (10.89 +/- 2.43 %mmHg(-1) x 10(-2)) to the dcSSc group (7.65 +/- 2.08 %mmHg(-1) x 10(-2)), even after adjustment for the systemic physiological and biochemical variables studied, which are known to influence the mechanics of arterial walls. There was no apparent difference between the groups in the mean elastic indices of the femoral artery and the IMT of the carotid and femoral arteries.
The elastic properties of the carotid artery are significantly altered in SSc, and the two major subsets of SSc may be distinguished by their carotid artery biomechanics. This suggests that connective tissue abnormality occurs at sites not previously assessed.
大血管动脉疾病日益被认为是自身免疫性风湿性疾病发病的主要原因。最近的证据表明，硬皮病（系统性硬化症，SSc）可能与15号染色体q臂缺陷相关的原纤维蛋白-1代谢改变有关。如果是这样，我们可能会在未临床累及疾病进程的大血管动脉壁力学方面看到变化。我们开展了一项研究，以确定弹性颈动脉和肌性股动脉的生物力学特性及内膜中层厚度（IMT）在局限性（lcSSc）和弥漫性（dcSSc）皮肤型SSc患者中是否发生改变。
使用与血管跟踪系统相连的双功扫描仪，对33例lcSSc患者、19例dcSSc患者和21例对照者的颈动脉和股动脉壁力学进行测量。还测量了他们的年龄、性别、体重指数、心率、收缩压和舒张压、假定的心血管负荷以及血浆肌酐、空腹胆固醇、甘油三酯和葡萄糖浓度。
即使在对已知会影响动脉壁力学的全身生理和生化变量进行校正后，从对照组（顺应性，16.24±4.39%mmHg⁻¹×10⁻²）到lcSSc组（10.89±2.43%mmHg⁻¹×10⁻²）再到dcSSc组（7.65±2.08%mmHg⁻¹×10⁻²），颈动脉的弹性特性仍出现渐进性显著降低（P<0.001）。股动脉平均弹性指数以及颈动脉和股动脉的IMT在各组之间无明显差异。
SSc患者颈动脉的弹性特性发生显著改变，SSc的两个主要亚型可通过其颈动脉生物力学加以区分。这表明结缔组织异常发生在以前未评估的部位。
