Andersson S E, Edvinsson M-L, Edvinsson L
Department of Internal Medicine, Lund University Hospital, S-226 85 Lund, Sweden.
Clin Sci (Lond). 2003 Dec;105(6):699-707. doi: 10.1042/CS20030037.
In the present study, we have investigated whether changes in vascular reactivity in congestive heart failure (CHF) patients can be detected in the cutaneous microvessels and whether these changes are due to endothelial dysfunction, are affected by increasing age and related to an ongoing inflammation. The responses to local warming and iontophoretically administered endothelium-dependent and -independent vasodilators were investigated in healthy young adults, healthy elderly adults and elderly adults with CHF. The results were correlated with plasma concentrations of vascular risk factors and markers for endothelial dysfunction and inflammation. The vasorelaxant responses were reduced in the elderly groups and were attenuated further in the CHF group. This group also had increases in levels of several markers associated with inflammation, higher blood glucose and homocysteine levels, a lower low-density lipoprotein-cholesterol and a rise in the concentration of von Willebrand factor, indicating a prothrombotic endothelial function. The severity of the heart failure, measured as the plasma level of brain natriuretic peptide, correlated with the intensity of inflammation and to the changes in vascular risk factors and endothelial function. It is concluded that the reactivity of the cutaneous microvessels is reduced with age, and the presence of CHF causes a further impairment. There is endothelial dysfunction in CHF, but it is uncertain to what extent this contributes to the reduced vasodilatory capacity. The inflammatory response appears central for many of the manifestations of the CHF syndrome.
在本研究中，我们调查了充血性心力衰竭（CHF）患者皮肤微血管中血管反应性的变化是否可被检测到，以及这些变化是否由内皮功能障碍引起、是否受年龄增长影响并与持续炎症相关。我们研究了健康年轻人、健康老年人以及老年CHF患者对局部升温以及经离子电渗法给予的内皮依赖性和非内皮依赖性血管扩张剂的反应。研究结果与血管危险因素的血浆浓度以及内皮功能障碍和炎症的标志物相关。老年组的血管舒张反应降低，而CHF组的反应进一步减弱。该组还出现了几种与炎症相关的标志物水平升高、血糖和同型半胱氨酸水平升高、低密度脂蛋白胆固醇降低以及血管性血友病因子浓度升高，表明存在促血栓形成的内皮功能。以脑钠肽血浆水平衡量的心力衰竭严重程度与炎症强度以及血管危险因素和内皮功能的变化相关。研究得出结论，皮肤微血管的反应性随年龄降低，而CHF的存在会导致进一步损害。CHF患者存在内皮功能障碍，但尚不确定其在多大程度上导致血管舒张能力降低。炎症反应似乎是CHF综合征许多表现的核心。
