Second Department of Internal Medicine, Tokyo Medical University, Japan.
Circ J. 2010 Jan;74(1):24-33. doi: 10.1253/circj.cj-09-0534. Epub 2009 Nov 17.
The arterial wall has 3 layers (ie, the intima, including the endothelium, the media, and the adventitia); each of these layers has individual roles in systemic circulation. The vascular endothelium regulates the vascular tone, hemostasis and/or vascular permeability, and the media is the major determinant of arterial elasticity, which regulates the conduit function (delivery of blood to tissues) and cushioning effect (for generation of continuous blood flow). Failure of these functions results in organ/vascular damage. Several non-invasive methods are currently used to assess vascular dysfunction, including measurement of flow-mediated vasodilatation of the brachial artery induced by reactive hyperemia (FMD), pulse wave velocity (PWV), the augmentation index (AI), and central blood pressure. Endothelial dysfunction, which is assessed by FMD, contributes to the initiation/progression of atherosclerosis. Increased arterial stiffness, which is assessed by the PWV and/or AI, causes increased cardiac afterload, impaired coronary arterial blood supply, atherogenesis and/or microvascular damage. The combination of risk stratification by assessment of conventional risk factors for cardiovascular disease (CVD) with not only a morphological assessment of vascular damage, such as carotid ultrasound examination, but also vascular function tests, may be a useful strategy for the management of CVD and its related risk factors. (Circ J 2010; 74: 24 - 33).
动脉壁有 3 层（即内膜，包括内皮细胞、中膜和外膜）；这些层各自在全身循环中发挥作用。血管内皮调节血管张力、止血和/或血管通透性，而中膜是动脉弹性的主要决定因素，它调节管道功能（向组织输送血液）和缓冲作用（产生连续的血流）。这些功能的衰竭会导致器官/血管损伤。目前有几种非侵入性方法可用于评估血管功能障碍，包括测量反应性充血引起的肱动脉血流介导的舒张（FMD）、脉搏波速度（PWV）、增强指数（AI）和中心血压。FMD 评估的内皮功能障碍导致动脉粥样硬化的发生/进展。由 PWV 和/或 AI 评估的动脉僵硬增加会导致心脏后负荷增加、冠状动脉血液供应受损、动脉粥样硬化形成和/或微血管损伤。通过评估心血管疾病（CVD）的传统危险因素进行风险分层，结合血管损伤的形态学评估，如颈动脉超声检查，以及血管功能测试，可能是 CVD 及其相关危险因素管理的有效策略。（Circ J 2010; 74: 24 - 33）。
