Dept. of Human Physiology, Univ. of Oregon, Eugene, OR 97403-1240, USA.
J Appl Physiol (1985). 2010 Oct;109(4):1239-46. doi: 10.1152/japplphysiol.00414.2010. Epub 2010 May 27.
With increased interest in predictive medicine, development of a relatively noninvasive technique that can improve prediction of major clinical outcomes has gained considerable attention. Current tests that are the target of critical evaluation, such as flow-mediated vasodilation of the brachial artery and pulse-wave velocity, are specific to the larger conduit vessels. However, evidence is mounting that functional changes in the microcirculation may be an early sign of globalized microvascular dysfunction. Thus development of a test of microvascular reactivity that could be used to evaluate cardiovascular risk or response to treatment is an exciting area of innovation. This mini-review is focused on tests of microvascular reactivity to thermal stimuli in the cutaneous circulation. The skin may prove to be an ideal site for evaluation of microvascular dysfunction due to its ease of access and growing evidence that changes in skin vascular reactivity may precede overt clinical signs of disease. Evaluation of the skin blood flow response to locally applied heat has already demonstrated prognostic utility, and the response to local cooling holds promise in patients in whom cutaneous disorders are present. Whether either of these tests can be used to predict cardiovascular morbidity or mortality in a clinical setting requires further evaluation.
随着人们对预测医学的兴趣日益浓厚，开发一种相对无创的技术来提高对主要临床结果的预测能力引起了广泛关注。目前，作为重点评估对象的检测方法，如肱动脉血流介导的血管舒张功能和脉搏波速度，仅针对较大的管道血管。然而，越来越多的证据表明，微循环的功能变化可能是全身微血管功能障碍的早期迹象。因此，开发一种可用于评估心血管风险或治疗反应的微血管反应性检测方法，是一个令人兴奋的创新领域。本篇小型综述聚焦于皮肤循环中热刺激的微血管反应性检测。由于皮肤易于接近，并且越来越多的证据表明，皮肤血管反应性的变化可能先于明显的疾病临床迹象，因此皮肤可能被证明是评估微血管功能障碍的理想部位。评估皮肤血流对局部应用热的反应已经显示出预后价值，而对局部冷却的反应在存在皮肤疾病的患者中具有很大的应用前景。这两种检测方法中的任何一种是否都可以用于预测临床环境中的心血管发病率或死亡率，还需要进一步评估。
