Chachaj Angelika, Puła Bartosz, Chabowski Mariusz, Grzegrzółka Jędrzej, Szahidewicz-Krupska Ewa, Karczewski Maciej, Janczak Dariusz, Dzięgiel Piotr, Podhorska-Okołów Marzenna, Mazur Grzegorz, Gamian Andrzej, Szuba Andrzej
1 Department of Angiology, Wroclaw Medical University , Wrocław, Poland .
2 Department of Internal Medicine, 4th Military Hospital in Wroclaw , Poland .
Lymphat Res Biol. 2018 Apr;16(2):140-146. doi: 10.1089/lrb.2017.0051. Epub 2018 Jan 18.
Recent studies, mainly on animal models, have suggested that negatively charged glycosaminoglycans, macrophages, and lymph vessels in the skin interstitium may serve as extrarenal control of sodium balance and blood pressure. The aim of the study was to prove the hypothesis that skin interstitium has a role in the pathogenesis of hypertension in humans.
We have examined skin biopsies in 91 patients from the department of surgery who had elective surgery with abdominal skin incision: 43 were hypertensive, 14 had resistant hypertension, and 34 with normal blood pressure as control group (median patients' age in these groups estimated accordingly 64 vs. 64 vs. 61.5; p > 0.05). We have studied (1) the content of Na, water, accumulation of macrophages (CD68), and density of lymphatic vessels (D2-40) and blood vessels (CD31) in the specimens of abdominal skin taken at the time of surgery and (2) plasma NT-proANP, vascular endothelial growth factor (VEGF)-C, and VEGF-D concentrations. The study groups differed in skin expression of CD68 (control vs. hypertension vs. resistant hypertension groups were accordingly: 3.33 vs. 4.00 vs. 8.33; p = 0.005) and in serum concentration of VEGF-C (5792 vs. 4348 vs. 3974 pg/mL; p = 0.026). Differences among groups in plasma NT-proANP levels were close to statistical significance (p = 0.056).
Our results confirm that skin interstitium may be involved in the pathogenesis of essential hypertension in humans. Lower levels of VEGF-C in hypertensive groups suggest that impairment of lymphangiogenesis and protective function of the skin lymphatic system may play a role in the pathogenesis of hypertension.
最近的研究，主要是在动物模型上进行的，表明皮肤间质中带负电荷的糖胺聚糖、巨噬细胞和淋巴管可能作为钠平衡和血压的肾外调节机制。本研究的目的是验证皮肤间质在人类高血压发病机制中起作用这一假说。
我们检查了外科科室91例行腹部皮肤切口择期手术患者的皮肤活检标本：43例为高血压患者，14例为顽固性高血压患者，34例血压正常者作为对照组（这些组患者的年龄中位数分别为64岁、64岁和61.5岁；p＞0.05）。我们研究了：（1）手术时采集的腹部皮肤标本中钠、水的含量、巨噬细胞（CD68）的聚集情况以及淋巴管（D2-40）和血管（CD31）的密度；（2）血浆N末端前心房钠尿肽（NT-proANP）、血管内皮生长因子（VEGF）-C和VEGF-D的浓度。研究组在CD68的皮肤表达（对照组、高血压组和顽固性高血压组分别为：3.33、4.00和8.33；p = 0.005）以及VEGF-C的血清浓度（5792、4348和3974 pg/mL；p = 0.026）方面存在差异。各组血浆NT-proANP水平的差异接近统计学意义（p = 0.056）。
我们的结果证实皮肤间质可能参与人类原发性高血压的发病机制。高血压组中VEGF-C水平较低表明淋巴管生成受损和皮肤淋巴系统的保护功能可能在高血压发病机制中起作用。
