Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Pensnett Road, Dudley, DY1 2HQ, West Midlands, UK.
Arthritis Res Ther. 2011 Jun 21;13(3):R99. doi: 10.1186/ar3374.
Patients with rheumatoid arthritis (RA) are at an increased risk for cardiovascular disease (CVD). One of the earliest manifestations of CVD is endothelial dysfunction (ED). ED can occur in both the microcirculation and the macrocirculation, and these manifestations might be relatively independent of each other. Little is known about the association between endothelial function in the microcirculation and the macrocirculation in RA. The objectives of the present study were to examine the relationship between microvascular and macrovascular endothelial function in patients with RA.
Ninety-nine RA patients (72 females, mean age (± SD) 56 ± 12 years), underwent assessments of endothelial-dependent (acetylcholine) and endothelial-independent (sodium nitroprusside) microvascular vasodilatory function (laser Doppler imaging with iontophoresis), as well as endothelial-dependent (flow-mediated dilation) and endothelial-independent (glyceryl trinitrate-mediated dilation) macrovascular vasodilatory function. Vasodilatory function was calculated as the percentage increase after each stimulus was applied relative to baseline values.
Pearson correlations showed that microvascular endothelial-dependent function was not associated with macrovascular endothelial-dependent function (r (90 patients) = 0.10, P = 0.34). Similarly, microvascular endothelial-independent function was not related to macrovascular endothelial-independent function (r (89 patients) = 0.00, P = 0.99).
Microvascular and macrovascular endothelial function were independent of each other in patients with RA, suggesting differential regulation of endothelial function in these two vascular beds. Assessments of both vascular beds may provide more meaningful clinical information on vascular risk in RA, but this hypothesis needs to be confirmed in long-term prospective studies.
类风湿关节炎（RA）患者发生心血管疾病（CVD）的风险增加。CVD 的最早表现之一是血管内皮功能障碍（ED）。ED 可发生在微循环和大循环中，这些表现可能彼此相对独立。RA 患者微循环和大循环内皮功能之间的关联知之甚少。本研究旨在探讨 RA 患者微血管和大血管内皮功能之间的关系。
99 例 RA 患者（72 例女性，平均年龄（± SD）56 ± 12 岁）接受内皮依赖性（乙酰胆碱）和内皮非依赖性（硝普钠）微血管舒张功能（激光多普勒成像离子电渗法）以及内皮依赖性（血流介导的舒张）和内皮非依赖性（甘油三硝酸酯介导的舒张）大血管舒张功能评估。舒张功能通过应用每种刺激物后相对于基线值的百分比增加来计算。
Pearson 相关性分析显示，微血管内皮依赖性功能与大血管内皮依赖性功能之间没有相关性（r（90 例患者）= 0.10，P = 0.34）。同样，微血管内皮非依赖性功能与大血管内皮非依赖性功能也没有相关性（r（89 例患者）= 0.00，P = 0.99）。
RA 患者的微血管和大血管内皮功能彼此独立，提示这两个血管床的内皮功能受到不同的调节。评估这两个血管床可能为 RA 中的血管风险提供更有意义的临床信息，但这一假说需要在长期前瞻性研究中得到证实。
