Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.
Basic Clin Pharmacol Toxicol. 2012 Jan;110(1):56-62. doi: 10.1111/j.1742-7843.2011.00786.x. Epub 2011 Oct 6.
In cardiovascular and metabolic diseases, small resistance arteries may show the presence of structural alterations. In particular, in essential hypertension, an increased media-to-lumen ratio of subcutaneous small arteries with no change in the total amount of vascular wall tissue (eutrophic remodelling) has already been described several years ago. Similar alterations have been demonstrated also in patients with diabetes mellitus and obesity; in this case, however, a more evident contribution of vascular smooth muscle cell growth (hypertrophic remodelling) is present. This review addresses the effects of obesity on small resistance artery structure. Similar to diabetic patients, obese patients show an increased media-to-lumen ratio of subcutaneous small arteries, which appears associated with hypertrophic remodelling, as demonstrated by an increase in media cross-sectional area. Endothelial dysfunction evaluated as vasodilator response to acetylcholine has also been observed. Several studies have shown that increased media-to-lumen ratio of subcutaneous small resistance arteries possesses a prognostic significance in relation to cardiovascular outcome. Appropriate antihypertensive treatment may improve microvascular alterations both in essential hypertension and in type 2 diabetes mellitus. In obesity, a pronounced weight loss may improve microvascular structure. However, further studies are needed to elucidate the effects of other pharmacological and non-pharmacological interventions in obesity.
在心血管和代谢疾病中，小阻力动脉可能显示出结构改变。特别是在原发性高血压中，已经描述了多年来皮下小动脉的中膜与内腔比增加而血管壁组织总量不变（肥大性重塑）。在糖尿病和肥胖患者中也已经证明了类似的改变；然而，在这种情况下，血管平滑肌细胞生长（肥大性重塑）的贡献更为明显。这篇综述探讨了肥胖对小阻力动脉结构的影响。与糖尿病患者类似，肥胖患者显示出皮下小动脉的中膜与内腔比增加，这似乎与肥厚性重塑有关，如中膜横截面积的增加所示。还观察到内皮功能障碍，表现为乙酰胆碱引起的血管舒张反应。几项研究表明，皮下小阻力动脉的中膜与内腔比增加与心血管结局有关，具有预后意义。适当的降压治疗可能改善原发性高血压和 2 型糖尿病患者的微血管改变。在肥胖中，明显的体重减轻可能改善微血管结构。然而，需要进一步的研究来阐明其他药理学和非药理学干预措施在肥胖中的作用。
