De Ciuceis Carolina, Porteri Enzo, Rizzoni Damiano, Rizzardi Nicola, Paiardi Silvia, Boari Gianluca E M, Miclini Marco, Zani Francesca, Muiesan Maria Lorenza, Donato Francesco, Salvetti Massimo, Castellano Maurizio, Tiberio Guido A M, Giulini Stefano M, Agabiti Rosei Enrico
Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.
Am J Hypertens. 2007 Aug;20(8):846-52. doi: 10.1016/j.amjhyper.2007.03.016.
Structural alterations in the microcirculation may be considered an important mechanism of organ damage. An increased tunica media to internal lumen ratio of subcutaneous small-resistance arteries (M:L) may predict the development of cardiovascular events in a high-risk population. However, it is not known whether structural alterations of small arteries may also predict major cardiovascular events.
Three hundred three subjects were included in the present study. There were 65 normotensive subjects, 111 patients with essential hypertension (33% of them with diabetes mellitus), 109 patients with secondary forms of hypertension, and 18 normotensive diabetic patients. Small-resistance arteries were dissected from subcutaneous fat biopsies and mounted on an isometric myograph, and the M:L was measured. Subjects were reevaluated after an average follow-up time of 6.9 years to assess the occurrence of cardio-cerebrovascular events.
Eleven subjects died of a fatal cardio-cerebrovascular event (FCE), 14 had a major, nonfatal cardiovascular event (stroke or myocardial infarction) (SMI), 23 had a minor cardiovascular event (MCE), and 255 had no cardiovascular event (NCE). A significant difference was observed in M:L and in event-free survival between patients with FCEs+SMIs+MCEs and those with NCE and between patients with FCEs+SMIs and those with NCE. Similar results were obtained by restricting the analysis to patients with essential hypertension.
Structural alterations of small-resistance arteries may predict FCE and SMI. The prognostic role of small-resistance artery structure also applies to medium-risk patients with essential hypertension, at least when MCEs are included in the analysis.
微循环的结构改变可能被认为是器官损伤的重要机制。皮下小阻力动脉中膜与内腔比值（M:L）增加可能预测高危人群心血管事件的发生。然而，小动脉的结构改变是否也能预测主要心血管事件尚不清楚。
本研究纳入303名受试者。其中有65名血压正常者，111名原发性高血压患者（其中33%患有糖尿病），109名继发性高血压患者，以及18名血压正常的糖尿病患者。从小块皮下脂肪活检中分离出小阻力动脉，并安装在等长肌动描记器上，测量M:L。在平均随访6.9年后对受试者进行重新评估，以评估心脑血管事件的发生情况。
11名受试者死于致命的心脑血管事件（FCE），14名发生了重大非致命心血管事件（中风或心肌梗死）（SMI），23名发生了轻微心血管事件（MCE），255名未发生心血管事件（NCE）。在发生FCE+SMI+MCE的患者与发生NCE的患者之间以及发生FCE+SMI的患者与发生NCE的患者之间，观察到M:L和无事件生存率存在显著差异。将分析局限于原发性高血压患者时也获得了类似结果。
小阻力动脉的结构改变可能预测FCE和SMI。小阻力动脉结构的预后作用也适用于中度风险的原发性高血压患者，至少在分析中纳入MCE时如此。
