Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
Clin Exp Hypertens. 2023 Dec 31;45(1):2267192. doi: 10.1080/10641963.2023.2267192. Epub 2023 Oct 16.
Microcirculatory endothelial dysfunction is a complex phenomenon that contributes to the development of cardiovascular disease. However, the relationship between microcirculatory endothelial dysfunction and macrovascular disease remains incompletely understood. Fluid overload is a risk factor for cardiovascular mortality in patients undergoing peritoneal dialysis. Therefore, we investigated the effects of chronic fluid overload on both the microcirculation and macrocirculation in these patients.
Thirty patients undergoing peritoneal dialysis were included in this cross-sectional study. We measured their central blood pressure and pulse wave velocity, assessed their microvascular endothelial function using drug-induced iontophoresis with laser Doppler flowmetry, and determined the amount of fluid overload using bioimpedance. We conducted a Spearman correlation analysis, univariate analysis, and stepwise multivariate regression models to determine the associations among the hemodynamic parameters.
Acetylcholine-induced iontophoresis with laser Doppler flowmetry showed a correlation with both brachial and central pulse pressure (PP), but not with pulse wave velocity. Fluid overload was associated with both central and brachial PP and remained an independent predictor of central PP even after adjusting for multiple factors. However, fluid overload was not associated with microcirculatory endothelial function.
In peritoneal dialysis patients, we observed a significant association between central PP and microvascular endothelial function, indicating a connection between macrocirculation and microcirculation. However, conclusive evidence regarding fluid overload as a mediator between these circulatory systems is lacking. Further research is needed to investigate this relationship.
微血管内皮功能障碍是一种复杂的现象，它会导致心血管疾病的发生。然而，微血管内皮功能障碍与大血管疾病之间的关系仍不完全清楚。液体超负荷是腹膜透析患者心血管死亡率的一个危险因素。因此，我们研究了慢性液体超负荷对这些患者的微循环和大循环的影响。
本横断面研究纳入了 30 名接受腹膜透析的患者。我们测量了他们的中心血压和脉搏波速度，使用激光多普勒血流仪进行药物诱导的离子电渗测量评估他们的微血管内皮功能，并使用生物阻抗法确定液体超负荷的量。我们进行了 Spearman 相关分析、单变量分析和逐步多元回归模型，以确定血流动力学参数之间的关联。
乙酰胆碱诱导的激光多普勒血流仪离子电渗与肱动脉和中心脉压（PP）都相关，但与脉搏波速度无关。液体超负荷与中心和肱动脉 PP 相关，即使在调整了多个因素后，它仍然是中心 PP 的独立预测因素。然而，液体超负荷与微血管内皮功能无关。
在腹膜透析患者中，我们观察到中心 PP 与微血管内皮功能之间存在显著关联，表明大循环和微循环之间存在联系。然而，关于液体超负荷作为这些循环系统之间的中介的证据尚不足。需要进一步的研究来探讨这种关系。
