Reimann Manja, Prieur Silke, Lippold Birgit, Bornstein Stefan R, Reichmann Heinz, Julius Ulrich, Ziemssen Tjalf
Autonomic and Neuroendocrinological Laboratory, Dept. of Neurology, University Hospital Carl Gustav Carus, Dresden University of Technology, Germany.
Atheroscler Suppl. 2009 Dec 29;10(5):39-43. doi: 10.1016/S1567-5688(09)71808-2.
Changes in the microcirculation per se may precede macrovascular changes, hence, may present a good surrogate for monitoring vascular changes during treatment. Using retinal vascular imaging techniques, we attempted to investigate the microvascular benefit of a single LDL apheresis in hypercholesterolemia.
Twenty-one hypercholesterolemic patients (57+/-15 years) on regular LDL apheresis treatment, seven women and 14 men, were examined for retinal endothelial function before and after a single LDL apheresis. The Dynamic Vessel Analyzer was applied for static and dynamic retinal vessel analysis. Retinal vessel diameter was measured at rest and during flicker light stimulation. Changes in vasodilation are expressed as percent changes over baseline.
Cholesterol fractions and triglycerides were reduced by 21-74 % by the LDL apheresis procedure. In hypercholesterolemic patients, flicker-induced vasodilation was diminished in both retinal arterioles and venules, but had significantly improved in retinal venules after a single LDL apheresis (p = 0.013). This increase in vasodilatory capacity of retinal venules was linked to a wider basal retinal venular caliber (p = 0.031), but was unrelated to changes in serum lipids (p > 0.05).
In hypercholesterolemia, abnormal retinal autoregulation is improved by a single LDL apheresis. Our findings suggest that venules represent a dynamic component, which is highly responsive to metabolic changes in the microcirculation.
微循环的变化本身可能先于大血管变化，因此，可能是监测治疗期间血管变化的良好替代指标。我们使用视网膜血管成像技术，试图研究单次低密度脂蛋白去除术对高胆固醇血症患者微血管的益处。
对21例接受定期低密度脂蛋白去除术治疗的高胆固醇血症患者（57±15岁，7名女性和14名男性）在单次低密度脂蛋白去除术前和术后检查视网膜内皮功能。应用动态血管分析仪进行静态和动态视网膜血管分析。在静息状态和闪烁光刺激期间测量视网膜血管直径。血管舒张的变化以相对于基线的百分比变化表示。
通过低密度脂蛋白去除术，胆固醇组分和甘油三酯降低了21%-74%。在高胆固醇血症患者中，视网膜小动脉和小静脉的闪烁诱导血管舒张均减弱，但单次低密度脂蛋白去除术后视网膜小静脉的血管舒张有显著改善（p = 0.013）。视网膜小静脉舒张能力的增加与较宽的基础视网膜小静脉管径有关（p = 0.031），但与血脂变化无关（p>0.05）。
在高胆固醇血症中，单次低密度脂蛋白去除术可改善异常的视网膜自动调节。我们的研究结果表明，小静脉代表一个动态成分，对微循环中的代谢变化高度敏感。
