Pluta Waldemar, Lubkowska Anna, Dudzińska Wioleta
Department of Functional Diagnostics and Physical Medicine, Pomeranian Medical University in Szczecin, Szczecin, 71-210, Poland.
Institute of Biology, University of Szczecin, Szczecin, 71-412, Poland.
Vasc Health Risk Manag. 2025 Sep 3;21:729-747. doi: 10.2147/VHRM.S519426. eCollection 2025.
The vascular endothelium is responsible for regulating vascular tone, maintaining fluid homeo-stasis, and preventing platelet aggregation, exhibits regulatory properties in vasorelaxation and vasoconstriction - it produces, among others, nitric oxide and endothelin. The imbalance of vasoactive molecules leads to the loss of their function, known as endothelial dysfunction. Impaired endothelial function is observed in people with metabolic disorders, often preceding the onset of the disease by several years. Endothelial function assessment can be performed using invasive (eg coronary angiography) and non-invasive (flow-dependent dilation, biochemical markers) techniques. Among metabolic abnormalities, increasing scientific interest has focused on metabolic obesity in normal-weight individuals. People with this type of obesity, despite having a normal body mass index, exhibit both metabolic abnormalities typical of obesity (including hypertension and type 2 diabetes) and endothelial dysfunction. This comprehensive review summarizes the current knowledge of the structure and function of the vascular endothelium, methodologies for assessment, and pathophysiological mechanisms of endothelial dysfunction in metabolic disorders, with particular emphasis on diagnostic approaches and clinical implications for cardiovascular risk stratification.
血管内皮负责调节血管张力、维持液体稳态并防止血小板聚集，在血管舒张和收缩中具有调节特性——它会产生一氧化氮和内皮素等物质。血管活性分子的失衡会导致其功能丧失，即所谓的内皮功能障碍。在患有代谢紊乱的人群中可观察到内皮功能受损，通常在疾病发作前数年就已出现。内皮功能评估可通过侵入性（如冠状动脉造影）和非侵入性（血流依赖性扩张、生化标志物）技术进行。在代谢异常中，越来越多的科学研究关注正常体重个体中的代谢性肥胖。患有这种类型肥胖的人，尽管体重指数正常，但仍表现出肥胖典型的代谢异常（包括高血压和2型糖尿病）以及内皮功能障碍。这篇综述总结了目前关于血管内皮结构和功能、评估方法以及代谢紊乱中内皮功能障碍病理生理机制的知识，特别强调了诊断方法以及对心血管风险分层的临床意义。
