Nakamura M, Chiba M, Ueshima K, Arakawa N, Yoshida H, Makita S, Funakoshi T, Hashimoto K, Ishikawa M, Hiramori K
2nd Dept of Internal Medicine, Iwate Medical University, Japan.
Int J Cardiol. 1995 Feb;48(2):139-46. doi: 10.1016/0167-5273(94)02229-c.
This study examined the peripheral endothelium-dependent vasodilatory response to acetylcholine and the endothelium-independent vasodilatory response to nitroprusside in 19 patients with chronic heart failure and eight controls. These peripheral blood flow responses were compared with hyperemic calf blood flow changes after maximum leg exercise and 5-min femoral occlusion. The peripheral blood flow response to forearm intra-arterial infusion of acetylcholine and sodium nitroprusside, and reactive hyperemic calf blood flow changes were measured by plethysmography. All peripheral blood flow responses were significantly reduced in patients with chronic heart failure (P < 0.05). Reduction of acetylcholine-mediated changes in peripheral blood flow was correlated with exercise-induced calf blood flow response (r = 0.51, P < 0.05), but not with occlusion-induced calf blood flow response (r = 0.02, NS). Sodium nitroprusside-mediated changes were not correlated with any reactive hyperemic blood flow responses (exercise: r = 0.27, NS; occlusion: r = 0.11, NS). When the patients were divided into two subgroups based on the median exercise-induced calf blood flow change, the subgroup with the lower calf blood flow response showed a reduction in exercise capacity (anaerobic threshold: 11.8 +/- 0.6 vs. 14.6 +/- 1.0 ml/kg/min; P < 0.05). These findings suggest that endothelial dysfunction is related to a decrease in exercise-induced skeletal muscle blood flow and exercise capacity in patients with chronic heart failure.
本研究检测了19例慢性心力衰竭患者和8例对照者对乙酰胆碱的外周内皮依赖性血管舒张反应以及对硝普钠的非内皮依赖性血管舒张反应。将这些外周血流反应与最大腿部运动和5分钟股动脉闭塞后充血的小腿血流变化进行比较。通过体积描记法测量前臂动脉内输注乙酰胆碱和硝普钠后的外周血流反应以及反应性充血的小腿血流变化。慢性心力衰竭患者的所有外周血流反应均显著降低（P<0.05）。乙酰胆碱介导的外周血流变化的降低与运动诱导的小腿血流反应相关（r = 0.51，P<0.05），但与闭塞诱导的小腿血流反应无关（r = 0.02，无统计学意义）。硝普钠介导的变化与任何反应性充血血流反应均无相关性（运动：r = 0.27，无统计学意义；闭塞：r = 0.11，无统计学意义）。当根据运动诱导的小腿血流变化中位数将患者分为两个亚组时，小腿血流反应较低的亚组显示运动能力下降（无氧阈值：11.8±0.6 vs. 14.6±1.0 ml/kg/min；P<0.05）。这些发现表明，内皮功能障碍与慢性心力衰竭患者运动诱导的骨骼肌血流减少和运动能力下降有关。
