J Clin Rheumatol. 2018 Jan;24(1):14-17. doi: 10.1097/RHU.0000000000000618.
The aim of this study was to assess the arterial distensibility of large vessels and changes in microvasculature in primary antiphospholipid syndrome.
Twenty-two antiphospholipid syndrome (APL) patients and 66 age-, sex-, height-, and blood pressure-matched controls were evaluated. Second derivative of the finger photoplethysmogram (SDPTG) was used as a noninvasive method to evaluate the pulse wave. The b/a and d/a indices, which reflect, respectively, large-vessel and small-vessel properties, were calculated from the SDPTG waveform components. Vascular age index was also determined.
Arterial thrombosis occurred in 59.1% (13/22) of APL patients, with a predominance of stroke episodes (61.5%). Venous thromboembolism was observed in 36.4% (all deep venous thrombosis), and obstetric complications in 36.4%. Frequency of diabetes mellitus, smoking, and dyslipidemia was comparable in APL patients and control subjects (P > 0.05). Concerning plethysmography findings, b/a ratio was higher in patients than in control subjects (-0.44 ± 0.16 vs. -0.54 ± 0.18, P = 0.034), whereas d/a ratio (-0.30 ± 0.16 vs. -0.31 ± 0.18, P = 0.83) was comparable. Moreover, SDPTG (-0.16 ± 0.35 vs. -0.30 ± 0.38, P = 0.16) and vascular age index values (53.5 ± 11.6 vs. 51.8 ± 16.1, P = 0.65) were alike in both groups. Regarding disease-related factors, patients with arterial and venous thrombosis had similar b/a, d/a, and vascular age indices (P = 0.95; P = 0.06; P = 0.12, respectively).
The higher b/a ratio in APL patients suggests decreased distensibility of large arteries and may be why APL patients are at higher risk for cardiovascular events. The d/a ratio, that is considered a marker of small vessel vascular resistance, was not different than controls. Further studies are needed to evaluate vascular factors that predispose APL patients to atherosclerotic events.
本研究旨在评估原发性抗磷脂综合征患者的大血管弹性和微血管变化。
评估了 22 名抗磷脂综合征（APL）患者和 66 名年龄、性别、身高和血压匹配的对照者。使用手指光体积描记图的二阶导数（SDPTG）作为一种非侵入性方法来评估脉搏波。从 SDPTG 波形分量计算分别反映大血管和小血管特性的 b/a 和 d/a 指数。还确定了血管年龄指数。
22 名 APL 患者中有 59.1%（13/22）发生动脉血栓形成，其中以中风发作为主（61.5%）。静脉血栓栓塞在 36.4%的患者中观察到（均为深静脉血栓形成），在 36.4%的患者中观察到产科并发症。APL 患者和对照组的糖尿病、吸烟和血脂异常的频率相当（P > 0.05）。关于容积描记术结果，患者的 b/a 比值高于对照组（-0.44 ± 0.16 对 -0.54 ± 0.18，P = 0.034），而 d/a 比值（-0.30 ± 0.16 对 -0.31 ± 0.18，P = 0.83）相似。此外，SDPTG（-0.16 ± 0.35 对 -0.30 ± 0.38，P = 0.16）和血管年龄指数值（53.5 ± 11.6 对 51.8 ± 16.1，P = 0.65）在两组之间相似。关于与疾病相关的因素，动脉和静脉血栓形成的患者具有相似的 b/a、d/a 和血管年龄指数（P = 0.95；P = 0.06；P = 0.12）。
APL 患者的 b/a 比值较高提示大动脉弹性降低，这可能是 APL 患者发生心血管事件风险增加的原因。被认为是小血管血管阻力标志物的 d/a 比值与对照组无差异。需要进一步研究评估使 APL 患者易患动脉粥样硬化事件的血管因素。
