Rizzoni Damiano, Aalkjaer Christian, De Ciuceis Carolina, Porteri Enzo, Rossini Claudia, Rosei Claudia Agabiti, Sarkar Annamaria, Rosei Enrico Agabiti
Clinica Medica, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.
High Blood Press Cardiovasc Prev. 2011 Dec 1;18(4):169-77. doi: 10.2165/11593640-000000000-00000.
Structural alterations of subcutaneous small resistance arteries, as indicated by an increased media to lumen ratio, are frequently present in hypertensive and/or diabetic patients. However, the evaluation of microvascular structure is not an easy task. Among the methods that may be applied to humans, plethysmographic evaluation of small arteries and wire or pressure micromyography were extensively used in the last decades. Media to lumen ratio of small arteries evaluated by micromyography was demonstrated to possess a strong prognostic significance; however, its extensive evaluation is limited by the invasiveness of the assessment, since a biopsy of subcutaneous fat is needed. Non-invasive approaches were then proposed, including capillaroscopy, which provides information about microvascular rarefaction. Recently, the interest of investigators has focused on the retinal microvascular bed. In particular, a non-invasive measurement of wall thickness to internal lumen ratio of retinal arterioles using scanning laser Doppler flowmetry has been recently introduced. Preliminary data suggest a fairly good agreement between this approach and micromyographic measurements, generally considered the gold standard approach. Therefore, the evaluation of microvascular structure is progressively moving from bench to bedside, and it could represent, in the immediate future, an evaluation to be performed in all hypertensive patients, in order to obtain a better stratification of cardiovascular risk.
皮下小阻力动脉的结构改变，如中膜与管腔比值增加所示，在高血压和/或糖尿病患者中经常出现。然而，微血管结构的评估并非易事。在可应用于人类的方法中，小动脉体积描记评估以及线式或压力微血管造影术在过去几十年中被广泛使用。通过微血管造影术评估的小动脉中膜与管腔比值被证明具有很强的预后意义；然而，由于需要对皮下脂肪进行活检，其广泛评估受到评估侵入性的限制。随后提出了非侵入性方法，包括毛细血管镜检查，它可提供有关微血管稀疏的信息。最近，研究人员的兴趣集中在视网膜微血管床。特别是，最近引入了一种使用扫描激光多普勒血流仪对视网膜小动脉壁厚度与内腔比值进行非侵入性测量的方法。初步数据表明，这种方法与通常被视为金标准方法的微血管造影测量之间有相当好的一致性。因此，微血管结构的评估正逐渐从实验室走向临床，在不久的将来，它可能代表对所有高血压患者都要进行的一种评估，以便更好地分层心血管风险。
