Pacholczak-Madej Renata, Kuszmiersz Piotr, Bazan-Socha Stanisława, Kosałka-Wêgiel Joanna, Iwaniec Teresa, Zarêba Lech, Kielczewski Stan, Rams Anna, Walocha Jerzy A, Musiał Jacek, Dropiñski Jerzy
Department of Anatomy, Jagiellonian University, Medical College, Krakow, Poland.
National Cancer Institute, Maria Skłodowska-Curie Memorial Institute, Krakow Branch, Poland.
Postepy Dermatol Alergol. 2020 Aug;37(4):495-502. doi: 10.5114/ada.2019.83501. Epub 2020 Sep 2.
Patients with systemic sclerosis experience endothelial dysfunction and damage even in the absence of clinical manifestations.
To evaluate various methods for assessing the endothelial function for their applicability to clinical practice.
Forty-two patients (7 men and 35 women) with systemic sclerosis and 36 controls (11 men and 25 women) matched for age, sex, body mass index, smoking habit, and comorbidities were enrolled in the study. We assessed each participant for typical risk factors for cardiovascular diseases and measured serum levels of vascular cell adhesion molecule-1 (VCAM-1) and thrombomodulin together with flow-mediated dilatation (FMD) of the brachial artery and intima-media thickness (IMT) of the common carotid artery using ultrasonography.
Patients with systemic sclerosis did not differ from controls in serum levels of VCAM-1 and thrombomodulin, however, the statistical analysis with adjustment for potential confounders revealed increased levels of thrombomodulin in the patients ( = 0.03). They also had a 45% lower relative increase of FMD (FMD%), and 13% higher IMT ( < 0.01, both, also after adjustment for potential confounders). In a simple regression model, lower FMD% was determined by age (β = -0.57, 95% confidence interval (CI): -0.72 to -0.43) and C-reactive protein levels (β = -0.38, 95% CI: -0.55 to -0.22). Thicker IMT was related to age (β = 0.64, 95% CI: 0.52-0.67), glomerular filtration rate (β = -0.34, 95% CI: -0.5 to -0.18), and blood thrombomodulin levels (β = 0.45, 95% CI: 0.13-0.76).
Patients with systemic sclerosis present with endothelial dysfunction which may be detected using ultrasonographic methods. The exact mechanism of observed abnormalities is unknown, but it is possibly related to the chronic inflammation and ischemia-reperfusion injury.
系统性硬化症患者即使在没有临床表现时也会出现内皮功能障碍和损伤。
评估各种评估内皮功能的方法在临床实践中的适用性。
本研究纳入了42例系统性硬化症患者（7例男性和35例女性）以及36例对照者（11例男性和25例女性），对照者在年龄、性别、体重指数、吸烟习惯和合并症方面与患者匹配。我们评估了每位参与者的心血管疾病典型危险因素，并使用超声测量了血清血管细胞黏附分子-1（VCAM-1）和血栓调节蛋白水平，同时测量了肱动脉的血流介导的血管舒张（FMD）和颈总动脉的内膜中层厚度（IMT）。
系统性硬化症患者与对照者在血清VCAM-1和血栓调节蛋白水平上无差异，然而，在对潜在混杂因素进行校正后的统计分析显示，患者的血栓调节蛋白水平升高（P = 0.03）。他们的FMD相对增加率（FMD%）也降低了45%，IMT升高了13%（两者P < 0.01，在对潜在混杂因素进行校正后也是如此）。在一个简单回归模型中，较低的FMD%由年龄（β = -0.57，95%置信区间（CI）：-0.72至-0.43）和C反应蛋白水平（β = -0.38，95% CI：-0.55至-0.22）决定。较厚的IMT与年龄（β = 0.64，95% CI：0.52 - 0.67）、肾小球滤过率（β = -0.34，95% CI：-0.5至-0.18）和血液血栓调节蛋白水平（β = 0.45，95% CI：0.13 - 0.76）有关。
系统性硬化症患者存在内皮功能障碍，可通过超声检查方法检测到。观察到的异常的确切机制尚不清楚，但可能与慢性炎症和缺血再灌注损伤有关。
