Harazny Joanna M, Ott Christian, Raff Ulrike, Welzenbach Jürgen, Kwella Norbert, Michelson Georg, Schmieder Roland E
aDepartment of Nephrology and Hypertension, University of Erlangen-Nuremberg, Erlangen-Nuremberg, Germany bDepartment of Pathophysiology cDepartment of Nephrology and Hypertension, University of Warmia and Masury, Olsztyn, Poland dDepartment of Ophthalmology, University of Erlangen-Nuremberg, Erlangen-Nuremberg, Germany.
J Hypertens. 2014 Nov;32(11):2246-52; discussion 2252. doi: 10.1097/HJH.0000000000000308.
Increased pulsatile pressure induces as well as aggravates microvascular damage. Scanning laser Doppler flowmetry allows the noninvasive assessment of both retinal capillary flow (RCF) and arteriolar structural parameters of the retinal circulation. Moreover, pulsatile characteristics of the retinal arterioles can be assessed.
In study 1, reliability of pulsatile RCF and structural parameters were examined in randomly selected patients. In study 2, pulsatile RCF as well as the structural parameters of retinal arterioles were assessed in hypertension grade 1-2 (HT1-2; n = 20) and treatment-resistant hypertension (TRH; n = 19).
In study 1, test-retest, interobserver and intraobserver reliability of all parameters showed coefficients of variation of less than 10%. In study 2, it was shown that patients with TRH had higher pulse pressure (P = 0.003) and pulsed RCF values (P < 0.001) as patients with HT1-2. Patients with HT1-2 had no change in the vessel diameter, but a significant difference in lumen diameter, resulting in an altered wall thickness (P = 0.001) between systole and diastole. In contrast, patients with TRH showed differences in vessel diameter (P = 0.005) as well as lumen diameter (P = 0.001), resulting in an unaltered wall thickness between systole and diastole. Hence, wall thickness change as a result of pulsed flow regulation observed in HT1-2 was missing in TRH.
We suggest a new reliable tool for evaluating the pulsatility in the retinal circulation in humans, and found significant differences in pulsatile RCF and structural parameters between patients with HT1-2 and those with TRH.
搏动压力升高会引发并加重微血管损伤。扫描激光多普勒血流仪可对视网膜毛细血管血流（RCF）和视网膜循环的小动脉结构参数进行无创评估。此外，还可评估视网膜小动脉的搏动特征。
在研究1中，对随机选取的患者的搏动性RCF和结构参数的可靠性进行了检查。在研究2中，对1-2级高血压（HT1-2；n = 20）和顽固性高血压（TRH；n = 19）患者的搏动性RCF以及视网膜小动脉的结构参数进行了评估。
在研究1中，所有参数的重测、观察者间和观察者内可靠性显示变异系数小于10%。在研究2中，结果表明，TRH患者的脉压（P = 0.003）和搏动性RCF值（P < 0.001）高于HT1-2患者。HT1-2患者的血管直径无变化，但管腔直径有显著差异，导致收缩期和舒张期之间的壁厚改变（P = 0.001）。相比之下，TRH患者的血管直径（P = 0.005）和管腔直径（P = 0.001）均有差异，导致收缩期和舒张期之间的壁厚未改变。因此，HT1-2患者中观察到的因搏动血流调节导致的壁厚变化在TRH患者中未出现。
我们提出了一种评估人类视网膜循环搏动性的新的可靠工具，并发现HT1-2患者和TRH患者在搏动性RCF和结构参数上存在显著差异。
