Rossi Pascal, Granel Brigitte, Marziale Dominique, Le Mée Fanny, Francès Yves
Internal Medicine department, North Hospital, Chemin des Bourrely, Marseille Cedex, France.
Clin Physiol Funct Imaging. 2010 Nov;30(6):453-9. doi: 10.1111/j.1475-097X.2010.00965.x. Epub 2010 Aug 15.
Systemic sclerosis (SSc) is characterized by the development of fibrosis of skin and internal organs that is associated with vascular damage. However, its related parameters have not been fully explored. The aim of this study was to investigate endothelial function in SSc and its relationship with systolic pulmonary artery pressure and systemic arterial compliance (SAC).
We studied 14 SSc females (4 with diffuse and 10 with limited cutaneous form of the disease) and 14 healthy controls matched for age and for cardiovascular risk factors. Endothelium-dependent dilation (i.e. flow-mediated) and endothelium-independent (i.e. nitroglycerin-induced) dilation of the brachial artery were measured as the percentage of change from baseline (FMD and NMD, respectively). In patients with SSc, SAC, cardiac output (CO), systemic arterial resistance and pulmonary artery pressure were estimated using echocardiography Doppler.
Heart rate, brachial artery pressure and body mass index did not differ between patients with SSc and controls. Flow-mediated vasodilation (FMD) and NMD were significantly decreased in patients with SSc (10.3 ± 8.6 versus 26.6 ± 7.4%, P<0.001; 24.2 ± 8.4 versus 33.3 ± 10.1%, P<0.001, respectively). Postischaemia reactive hyperaemia was lower in patients with SSc (275 ± 185 versus 618 ± 366%, P<0.001). FMD and nitrate-mediated dilation (NMD) were associated with CO, but not with SAC; moreover, FMD correlated with pulmonary artery pressure and peripheral arterial resistance conversely to NMD.
Endothelium function in SSc is impaired independently to SAC. Furthermore, the severity of both small artery and pulmonary artery involvement may impact on endothelium-dependent function.
系统性硬化症（SSc）的特征是皮肤和内脏器官发生纤维化，并伴有血管损伤。然而，其相关参数尚未得到充分研究。本研究的目的是调查SSc患者的内皮功能及其与收缩期肺动脉压和全身动脉顺应性（SAC）的关系。
我们研究了14名SSc女性患者（4名弥漫型和10名局限型皮肤病变患者）以及14名年龄和心血管危险因素相匹配的健康对照者。测量肱动脉的内皮依赖性扩张（即血流介导的）和内皮非依赖性（即硝酸甘油诱导的）扩张，以相对于基线的变化百分比表示（分别为FMD和NMD）。对于SSc患者，使用超声心动图多普勒估计SAC、心输出量（CO）、全身动脉阻力和肺动脉压。
SSc患者与对照组之间的心率、肱动脉压和体重指数无差异。SSc患者的血流介导的血管舒张（FMD）和NMD显著降低（分别为10.3±8.6对26.6±7.4%，P<0.001；24.2±8.4对33.3±10.1%，P<0.001）。SSc患者缺血后反应性充血较低（275±185对618±366%，P<0.001）。FMD和硝酸盐介导的扩张（NMD）与CO相关，但与SAC无关；此外，与NMD相反，FMD与肺动脉压和外周动脉阻力相关。
SSc患者的内皮功能独立于SAC受损。此外，小动脉和肺动脉受累的严重程度可能会影响内皮依赖性功能。
