Dimitroulas T, Giannakoulas G, Sfetsios T, Karvounis H, Dimitroula H, Koliakos G, Settas L
First Department of Internal Medicine, AHEPA University Hospital, Stilp. Kiriakidi 1, Thessaloniki 54636, Greece.
Rheumatology (Oxford). 2008 Nov;47(11):1682-5. doi: 10.1093/rheumatology/ken346. Epub 2008 Aug 27.
SSc is a CTD characterized by vascular involvement, with generalized disturbance of the microcirculation, which may lead to pulmonary artery hypertension (PAH). Asymmetrical dimethylarginine (ADMA) is an endogenous nitric oxide (NO) inhibitor. Increased concentrations of plasma ADMA may also contribute to endothelial dysfunction in patients with pulmonary vascular disease. The aim of our study was to elucidate the possible relationship between serum ADMA and PAH in patients with SSc. Moreover, we sought to investigate the effect of ADMA levels on the functional capacity of these patients.
Plasma ADMA levels were measured in 66 patients with SSc (63 females, mean age 57.8 +/- 12.8 yrs, median duration of disease 9.9 yrs, 47 with lcSSc and 19 with dcSSc disease) and 30 healthy controls (29 females, mean age 58.2 +/- 8.4 yrs). Systolic pulmonary artery pressure (sPAP) assessed by echocardiography, lung function tests, 6-min walk test (6MWT) and serum ADMA levels were recorded from patients.
In 24 patients, the diagnosis of PAH was established. Mean value of ADMA for SScPAH patients was 0.44 +/- 0.22 micromol/l compared with 0.26 +/- 0.18 micromol/l for patients without PAH and 0.25 +/- 0.20 micromol/l for controls (P = 0.001). ADMA levels were inversely correlated with the 6MWT (r = -0.55, P = 0.005).
In patients with SScPAH, increased ADMA serum levels and their negative association with exercise capacity suggests that the NO pathway is involved in the development of pulmonary vascular disease.
系统性硬化症（SSc）是一种以血管受累为特征的结缔组织病，伴有微循环的广泛性紊乱，这可能导致肺动脉高压（PAH）。不对称二甲基精氨酸（ADMA）是一种内源性一氧化氮（NO）抑制剂。血浆ADMA浓度升高也可能导致肺血管疾病患者的内皮功能障碍。我们研究的目的是阐明SSc患者血清ADMA与PAH之间的可能关系。此外，我们试图研究ADMA水平对这些患者功能能力的影响。
测量了66例SSc患者（63例女性，平均年龄57.8±12.8岁，疾病中位病程9.9年，47例局限性皮肤型SSc和19例弥漫性皮肤型SSc）和30例健康对照者（29例女性，平均年龄58.2±8.4岁）的血浆ADMA水平。记录了患者通过超声心动图评估的收缩期肺动脉压（sPAP）、肺功能测试、6分钟步行试验（6MWT）和血清ADMA水平。
24例患者确诊为PAH。SSc-PAH患者的ADMA平均值为0.44±0.22微摩尔/升，无PAH患者为0.26±0.18微摩尔/升，对照组为0.25±0.20微摩尔/升（P = 0.001）。ADMA水平与6MWT呈负相关（r = -0.55，P = 0.005）。
在SSc-PAH患者中，ADMA血清水平升高及其与运动能力的负相关表明NO途径参与了肺血管疾病的发生发展。
