Rajagopalan Sanjay, Pfenninger Dana, Kehrer Christine, Chakrabarti Anjan, Somers Emily, Pavlic Robert, Mukherjee Debabrata, Brook Robert, D'Alecy Louis G, Kaplan Mariana J
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109-0273, USA.
Arthritis Rheum. 2003 Jul;48(7):1992-2000. doi: 10.1002/art.11060.
To compare microvascular and macrovascular functions in a cohort of patients with primary and secondary Raynaud's phenomenon (RP) who were matched for demographic, risk factor, and severity profiles.
Forty patients with primary or secondary RP matched for vascular risk factors and severity scores underwent testing of endothelial function and cold pressor responsiveness of the brachial artery. Microvascular perfusion of the digital vasculature was assessed using laser Doppler fluxmetry in response to reactive hyperemia. Plasma was assayed for endothelin 1 (ET-1), asymmetric dimethylarginine (ADMA), intercellular adhesion molecule 1, vascular cell adhesion molecule 1 (VCAM-1), and monocyte chemoattractant protein 1 (MCP-1).
Patients with RP had abnormal vasoconstrictor responses to cold pressor tests (CPT) that were similar in primary and secondary RP. There were no differences in median flow-mediated and nitroglycerin-mediated dilation or CPT of the brachial artery in the 2 populations. Patients with secondary RP were characterized by abnormalities in microvascular responses to reactive hyperemia, with a reduction in area under the curve adjusted for baseline perfusion, but not in time to peak response or peak perfusion ratio. Plasma ET-1, ADMA, VCAM-1, and MCP-1 levels were significantly elevated in secondary RP compared with primary RP. There was a significant negative correlation between ET-1 and ADMA values and measures of microvascular perfusion but not macrovascular endothelial function.
Secondary RP is characterized by elevations in plasma ET-1 and ADMA levels that may contribute to alterations in cutaneous microvascular function.
比较一组原发性和继发性雷诺现象（RP）患者的微血管和大血管功能，这些患者在人口统计学、危险因素和严重程度方面相匹配。
40例原发性或继发性RP患者，其血管危险因素和严重程度评分相匹配，接受了肱动脉内皮功能和冷加压反应性测试。使用激光多普勒血流仪评估指端血管对反应性充血的微血管灌注情况。检测血浆中内皮素1（ET-1）、不对称二甲基精氨酸（ADMA）、细胞间黏附分子1、血管细胞黏附分子1（VCAM-1）和单核细胞趋化蛋白1（MCP-1）的水平。
RP患者对冷加压试验（CPT）的血管收缩反应异常，原发性和继发性RP患者相似。两组人群在肱动脉的中位血流介导的扩张、硝酸甘油介导的扩张或CPT方面无差异。继发性RP患者的特征是对反应性充血的微血管反应异常，经基线灌注调整后的曲线下面积减少，但达到峰值反应的时间或峰值灌注率无差异。与原发性RP相比，继发性RP患者血浆ET-1、ADMA、VCAM-1和MCP-1水平显著升高。ET-1和ADMA值与微血管灌注指标之间存在显著负相关，但与大血管内皮功能无关。
继发性RP的特征是血浆ET-1和ADMA水平升高，这可能导致皮肤微血管功能改变。
