Bartoli Francesca, Blagojevic Jelena, Bacci Marzia, Fiori Ginevra, Tempestini Alessio, Conforti Maria Letizia, Guiducci Serena, Miniati Irene, Di Chicco Mauro, Del Rosso Angela, Perfetto Federico, Castellani Sergio, Pignone Alberto, Cerinic Marco Matucci
Department of Medicine and Surgery, Division Medicine 1 and 2 and Rheumatology, Villa Monna Tessa, University of Florence, Florence, Italy.
Ann N Y Acad Sci. 2007 Jun;1108:283-90. doi: 10.1196/annals.1422.030.
Increased evidence suggests an accelerated macrovascular disease in systemic sclerosis (SSc). Brachial artery flow-mediated vasodilation (FMD) and carotid intima-media thickness (IMT) are two indicators of subclinic cardiovascular disease and are frequently used as surrogate measures of subclinic atherosclerosis. The aim of this study was to evaluate macrovascular involvement in SSc. We studied 35 SSc patients (6 males and 29 females; 11 with diffuse and 24 with limited disease) and 20 healthy controls. Brachial artery FMD was assessed by method described by Celermajer in all patients and 13 control subjects. IMT was measured using high-resolution B-mode ultrasonography in patients and controls. Traditional risk factors for atherosclerosis (hypertension, dyslipidemia, and smoke) were also assessed. FMD was significantly impaired (3.41% +/- 4.56% versus 7.66% +/- 4.24%; P < 0.037) and IMT was significantly elevated compared with healthy controls (0.93 +/- 0.29 mm versus 0.77 +/- 0.13 mm; P < 0.005). FMD was not significantly different in SSc with increased IMT compared with those with normal IMT). No correlation was found between risk factors for atherosclerosis and the impairment of FMD or IMT in SSc patients. The impairment of endothelial function and structural changes of large vessels are evident in SSc, but do not seem associated with traditional risk factors for atherosclerosis. Prospective studies including also clinical outcomes are needed to assess the features and significance of macrovacular involvement in SSc.
越来越多的证据表明系统性硬化症（SSc）患者的大血管疾病进展加速。肱动脉血流介导的血管舒张（FMD）和颈动脉内膜中层厚度（IMT）是亚临床心血管疾病的两个指标，常被用作亚临床动脉粥样硬化的替代指标。本研究旨在评估SSc患者的大血管受累情况。我们研究了35例SSc患者（6例男性和29例女性；11例弥漫性疾病患者和24例局限性疾病患者）以及20名健康对照者。采用Celermajer描述的方法对所有患者和13名对照者进行肱动脉FMD评估。使用高分辨率B型超声对患者和对照者测量IMT。还评估了动脉粥样硬化的传统危险因素（高血压、血脂异常和吸烟）。与健康对照者相比，SSc患者的FMD显著受损（3.41%±4.56%对7.66%±4.24%；P<0.037），IMT显著升高（0.93±0.29mm对0.77±0.13mm；P<0.005）。IMT增加的SSc患者与IMT正常的患者相比，FMD无显著差异。在SSc患者中，未发现动脉粥样硬化危险因素与FMD或IMT受损之间存在相关性。SSc患者存在内皮功能受损和大血管结构改变，但似乎与动脉粥样硬化的传统危险因素无关。需要开展包括临床结局的前瞻性研究，以评估SSc患者大血管受累的特征和意义。
