Tuygun Abdullah Kemal, Tuygun Aybanu, Yurtseven Nurgül, Sensöz Yavuz, Günay Rafet, Keser Mustafa, Tuygun Ulvi Hakan, Ketenci Bülent, Sahin Sinan, Yekeler Ibrahim
Department of Cardiovascular Surgery, Siyami Ersek Thoracic and Cardiovascular Surgery Training Hospital, Istanbul, Turkey.
Ann Vasc Surg. 2011 May;25(4):547-54. doi: 10.1016/j.avsg.2010.12.011. Epub 2011 Mar 25.
Endothelial dysfunction may play a major role in both peripheral arterial disease (PAD) and Buerger's disease (BD). Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelial nitric oxide synthase and increased ADMA levels impair vascular homeostasis. We aimed to determine the plasma levels of ADMA and evaluate the relationship of ADMA levels with smoking and clinical severity of the disease in patients with BD and to compare these results with those of patients with PAD and healthy individuals.
In our center, 45 patients undergoing peripheral arterial surgery, 28 patients being followed up for BD, and 24 healthy individuals without vascular or cardiac disease, were enrolled in the study. Intra- and intergroup analysis was performed to evaluate the relationship of ADMA levels with smoking behaviors and clinical disease severity according to Fontaine classification.
ADMA levels were 1.26 ± 0.76 mmol/L, 0.87 ± 0.27 mmol/L, and 1.07 ± 0.88 mmol/L in patients with PAD, in patients with BD, and in the control group, respectively. ADMA levels were significantly higher in patients with PAD than those in control patients (p = 0.003) and the levels observed in patients with BD were significantly lower than those in control patients (p = 0.001). Smokers with PAD had higher ADMA levels than smokers with BD (p = 0.03). ADMA levels were higher in patients with Fontaine stage III and IV disease than those with Fontaine stage II diseases, for patients with PAD as well as those with BD.
The lower ADMA levels observed in patients with BD might be related to the degradation of ADMA by dimethylarginine dimethylaminohydrolase in response to ischemia and could act as a defensive mechanism during the acute or quiescent phases. In patients with BD experiencing severe clinical conditions or with a longer time course for the disease, higher ADMA levels may suggest a poor prognosis.
内皮功能障碍可能在周围动脉疾病（PAD）和血栓闭塞性脉管炎（BD）中起主要作用。不对称二甲基精氨酸（ADMA）是内皮型一氧化氮合酶的内源性抑制剂，ADMA水平升高会损害血管稳态。我们旨在测定BD患者血浆中ADMA水平，评估ADMA水平与吸烟及疾病临床严重程度的关系，并将这些结果与PAD患者及健康个体的结果进行比较。
在我们中心，45例行周围动脉手术的患者、28例接受BD随访的患者以及24例无血管或心脏疾病的健康个体纳入本研究。根据Fontaine分级进行组内和组间分析，以评估ADMA水平与吸烟行为及临床疾病严重程度的关系。
PAD患者、BD患者和对照组的ADMA水平分别为1.26±0.76 mmol/L、0.87±0.27 mmol/L和1.07±0.88 mmol/L。PAD患者的ADMA水平显著高于对照组患者（p = 0.003），BD患者的ADMA水平显著低于对照组患者（p = 0.001）。PAD吸烟者的ADMA水平高于BD吸烟者（p = 0.03）。对于PAD患者和BD患者，Fontaine III期和IV期疾病患者的ADMA水平高于Fontaine II期疾病患者。
BD患者中观察到的较低ADMA水平可能与缺血时二甲基精氨酸二甲胺水解酶对ADMA的降解有关，并且可能在急性期或静止期作为一种防御机制。在临床病情严重或病程较长的BD患者中，较高的ADMA水平可能提示预后不良。
