Hôpital F.H. Manhès, 8 rue Roger Clavier, 91712 Fleury-Mérogis CEDEX, France.
Clin J Am Soc Nephrol. 2011 Aug;6(8):2009-15. doi: 10.2215/CJN.01260211. Epub 2011 Jul 22.
An intact endothelium is essential for adaptations between arterial vasomotor tone and shear stress (SS), i.e., flow-mediated vasodilation (FMD). Endothelial dysfunction occurs in hypertension, cardiac insufficiency, diabetes, atherosclerosis, and in end-stage renal disease (ESRD) patients, whose renal failure is associated with many of those cardiovascular diseases (CVD).
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using a progressive hand-warming protocol and repeated measures ANOVA, we analyzed SS-mediated increase of brachial artery diameter (ΔBA) in 22 healthy controls, 18 CVD-negative ESRD patients (ESRD-CVD(-)), and 17 CVD-positive ESRD patients (ESRD-CVD(+)) to analyze the role of uremia versus CVD on FMD.
Hand-warming increased SS (P < 0.001) and ΔBA (P < 0.001). Negative interactions were observed between ΔBA and ESRD (P < 0.001), and between ΔBA and CVD(+) (P < 0.02), but there was no interaction between ESRD and CVD(+) (P = 0.69). For low and mild SS increases, ESRD-CVD(-) patients were characterized by similar ΔBA as controls, but it was lower than controls at higher SS (P < 0.01). In ESRD-CVD(+) patients, brachial artery diameter did not respond to mild and moderate SS increases, and showed "paradoxical" vasoconstriction at higher SS (P < 0.05). In ESRD, a positive and independent interaction was observed between ΔBA and 25(OH) vitamin D(3) insufficiency (≤15 μg/L; P < 0.02).
These observations indicate that, independently of each other, ESRD and CVD(+) history are associated with endothelial dysfunction. They also suggest the importance of considering the relationships between SS and endothelial function in different clinical conditions.
完整的血管内皮对于动脉血管舒缩张力（SS）与剪切力（SS）之间的适应性至关重要，即血流介导的血管扩张（FMD）。内皮功能障碍发生于高血压、心功能不全、糖尿病、动脉粥样硬化和终末期肾病（ESRD）患者中，而这些患者的肾衰竭与许多心血管疾病（CVD）相关。
设计、设置、参与者和测量：我们使用渐进式手部升温方案和重复测量方差分析，分析了 22 名健康对照者、18 名 CVD 阴性 ESRD 患者（ESRD-CVD(-)）和 17 名 CVD 阳性 ESRD 患者（ESRD-CVD(+)）的 SS 介导的肱动脉直径增加（ΔBA），以分析尿毒症与 CVD 对 FMD 的作用。
手部升温增加了 SS（P<0.001）和ΔBA（P<0.001）。ΔBA 与 ESRD（P<0.001）和 CVD(+)（P<0.02）之间存在负交互作用，但 ESRD 与 CVD(+)（P=0.69）之间无交互作用。对于低和轻度 SS 增加，ESRD-CVD(-)患者的ΔBA 与对照组相似，但在更高的 SS 时低于对照组（P<0.01）。在 ESRD-CVD(+)患者中，肱动脉直径对轻度和中度 SS 增加没有反应，并且在更高的 SS 时表现出“反常”的血管收缩（P<0.05）。在 ESRD 中，ΔBA 与 25(OH) 维生素 D(3)不足（≤15μg/L；P<0.02）之间存在正独立交互作用。
这些观察结果表明，尿毒症和 CVD(+)病史彼此独立，与内皮功能障碍相关。它们还表明，在不同的临床情况下，考虑 SS 与内皮功能之间的关系非常重要。
