Klonizakis M, Yeung J M C, Nash J R, Lingam K, Manning G, Donnelly R
Division of Vascular Medicine, University of Nottingham, Derby, UK.
Eur J Vasc Endovasc Surg. 2003 Jul;26(1):100-4. doi: 10.1053/ejvs.2002.1953.
To assess the effects of posture, endothelial function and venous insufficiency on cutaneous microvascular vasodilator function in the gaiter area, in particular defining factors which may affect microangiopathy and ulcer formation.
Endothelial-dependent and -independent vasodilator responses to incremental-doses of acetylcholine (Ach) and sodium nitroprusside (SNP) were evaluated in the perimalleolar region in the supine and standing positions in middle-aged patients with isolated superficial venous insufficiency (ISVI) (n = 25) and healthy controls (n = 28) using laser Doppler fluximetry (LDF) and iontophoresis of vasodilators.
The venoarteriolar reflex (vasoconstriction on standing) was equally present in both groups, and reduced the vasodilator responses to SNP in the upright position (e.g., for patients with ISVI, peak SNP response was 82 +/- 11 PU [standing] vs 123 +/- 15 PU [supine]). The presence of ISVI had no effect on endothelial vasodilator function in the supine position, but on standing cutaneous reactivity to Ach was significantly reduced (e.g., peak Ach response 69 +/- 8 PU [ISVI] vs 109 +/- 11 PU [controls], p < 0.003).
Upright posture impairs cutaneous endothelial-dependent vasodilation in the gaiter area of patients with ISVI. This may be of clinical and prognostic utility in identifying which patients with uncomplicated ISVI are at highest risk of tissue breakdown and ulcer formation in the gaiter area.
评估姿势、内皮功能和静脉功能不全对踝周区域皮肤微血管舒张功能的影响，尤其确定可能影响微血管病变和溃疡形成的因素。
采用激光多普勒血流仪（LDF）和血管舒张剂离子导入法，对25例单纯性浅静脉功能不全（ISVI）中年患者和28例健康对照者在仰卧位和站立位时，踝周区域对递增剂量乙酰胆碱（Ach）和硝普钠（SNP）的内皮依赖性和非内皮依赖性血管舒张反应进行评估。
两组均存在静脉-动脉反射（站立时血管收缩），且在直立位时该反射降低了对SNP的血管舒张反应（例如，对于ISVI患者，SNP的峰值反应在站立位时为82±11 PU，而在仰卧位时为123±15 PU）。ISVI的存在对仰卧位时的内皮血管舒张功能无影响，但站立时对Ach的皮肤反应性显著降低（例如，Ach的峰值反应在ISVI患者中为69±8 PU，而在对照组中为109±11 PU，p<0.003）。
直立姿势会损害ISVI患者踝周区域的皮肤内皮依赖性血管舒张功能。这对于识别哪些单纯性ISVI患者在踝周区域发生组织破坏和溃疡形成的风险最高可能具有临床和预后意义。
