类风湿关节炎患者的前臂血流动力学、动脉僵硬度及微循环反应性

Forearm haemodynamics, arterial stiffness and microcirculatory reactivity in rheumatoid arthritis.

作者信息

Arosio Enrico, De Marchi Sergio, Rigoni Anna, Prior Manlio, Delva Pietro, Lechi Alessandro

机构信息

Division of Cardiovascular Rehabilitation, University of Verona, Verona, Italy.

出版信息

J Hypertens. 2007 Jun;25(6):1273-8. doi: 10.1097/HJH.0b013e3280b0157e.

DOI:10.1097/HJH.0b013e3280b0157e

PMID:17563541

Abstract

OBJECTIVES

Cardiovascular disease is the major cause of mortality in patients with rheumatoid arthritis. This work studied the presence of impaired forearm haemodynamics, arterial stiffness and microcirculatory reactivity in young women with rheumatoid arthritis.

METHODS

Sixty-five women aged 41-52 years, with rheumatoid arthritis, were screened for the absence of common cardiovascular risk factors. They underwent laser Doppler study on the hand at rest and after ischaemia, endothelium-dependent dilation with colour Doppler ultrasound and pulsewave velocity (PWV). Forty healthy subjects were also examined.

RESULTS

Microcirculatory flux at rest with laser Doppler was reduced in rheumatoid arthritis patients (112 +/- 45 versus 220 +/- 65 perfusion units (PU, arbitrary units); P < 0.005), post-ischaemic peak flow was lower in rheumatoid arthritis patients (235 +/- 65 versus 329 +/- 76 PU; P < 0.05); percentage increase in peak flow was higher in rheumatoid arthritis patients compared with healthy subjects (153 +/- 12 versus 65 +/- 18%; P < 0.005). Time to peak flow was longer in rheumatoid arthritis patients (12.7 +/- 8 versus 6.2 +/- 2 s; P < 0.005). Higher microcirculatory resistance was detected in rheumatoid arthritis patients (0.656 +/- 0.011 versus 0.358 +/- 0.009 mmHg/PU; P < 0.05). Endothelium-dependent dilation was impaired in rheumatoid arthritis patients (increase in artery dilation 8.2 +/- 2 versus 11.5 +/- 3%; P < 0.05) and correlated directly with actual C-reactive protein. PWV was higher in rheumatoid arthritis patients (9.3 +/- 0.2 versus 8.4 +/- 0.4 m/s; P < 0.05) and correlated directly with the duration of disease. District resistance by the arm was higher in rheumatoid arthritis patients (1098 +/- 190 versus 661 +/- 55 mmHg/l per minute; P < 0.005).

CONCLUSION

Female rheumatoid arthritis patients present with impaired microcirculatory reactivity, endothelial dysfunction and increased arterial stiffness. Alterations in the vascular bed are extended and may explain the increased incidence of cardiovascular events in these patients.

摘要

目的

心血管疾病是类风湿关节炎患者死亡的主要原因。本研究探讨了类风湿关节炎年轻女性患者前臂血流动力学受损、动脉僵硬度和微循环反应性的情况。

方法

对65名年龄在41 - 52岁的类风湿关节炎女性患者进行筛查，排除常见心血管危险因素。她们接受了静息及缺血后手部激光多普勒研究、彩色多普勒超声内皮依赖性舒张功能检测和脉搏波速度（PWV）检测。同时对40名健康受试者进行了检查。

结果

类风湿关节炎患者静息时激光多普勒微循环血流量减少（112±45对比220±65灌注单位（PU，任意单位）；P<0.005），缺血后峰值血流较低（235±65对比329±76 PU；P<0.05）；类风湿关节炎患者峰值血流增加百分比高于健康受试者（153±12对比65±18%；P<0.005）。类风湿关节炎患者达到峰值血流的时间更长（12.7±8对比6.2±2秒；P<0.005）。类风湿关节炎患者检测到更高的微循环阻力（0.656±0.011对比0.358±0.009 mmHg/PU；P<0.05）。类风湿关节炎患者内皮依赖性舒张功能受损（动脉扩张增加8.2±2对比11.5±3%；P<0.05），且与实际C反应蛋白直接相关。类风湿关节炎患者的PWV更高（9.3±0.2对比8.4±0.4 m/s；P<0.05），且与疾病持续时间直接相关。类风湿关节炎患者手臂区域阻力更高（1098±190对比661±55 mmHg/l每分钟；P<0.005）。