Nakamura M, Ishikawa M, Funakoshi T, Hashimoto K, Chiba M, Hiramori K
Second Department of Internal Medicine Iwate Medical University, Japan.
Am Heart J. 1994 Dec;128(6 Pt 1):1164-9. doi: 10.1016/0002-8703(94)90747-1.
Impairment of endothelium-dependent vasodilation has recently been reported in the peripheral vascular bed in patients with chronic heart failure. However, the clinical implications of this type of vascular dysfunction have yet to be elucidated. We have determined the degree of impairment of endothelium-dependent vasodilation as evaluated by acetylcholine-induced changes in forearm blood flow and compared this to various clinical parameters in 23 patients with chronic heart failure. Cumulative changes in forearm blood flow induced by acetylcholine (3.0 and 4.5 micrograms/min/dl tissue volume) were significantly lower in patients with chronic heart failure than in normal controls (10.1 +/- 8.0 ml/min/100 ml vs 20.4 +/- 11.7 ml/min/100 ml tissue volume; p < 0.01). In patients with heart failure, no significant relation was found between acetylcholine-induced changes in forearm blood flow and age, sex, duration of symptoms, duration of hospital stay, or resting hemodynamic parameters, although a significant positive correlation was observed with peak oxygen uptake (r = 0.53, p < 0.05) and ventilatory threshold (r = 0.42, p < 0.05). These observations suggest that the impairment of endothelium-dependent peripheral vasodilation may be one of the factors contributing to exercise intolerance in patients with chronic heart failure, probably resulting from its limiting effect on nutritive skeletal muscle blood flow during exercise.
最近有报道称，慢性心力衰竭患者的外周血管床存在内皮依赖性血管舒张功能受损的情况。然而，这种血管功能障碍的临床意义尚未阐明。我们通过乙酰胆碱诱导的前臂血流变化来评估内皮依赖性血管舒张功能的受损程度，并将其与23例慢性心力衰竭患者的各种临床参数进行了比较。慢性心力衰竭患者中，乙酰胆碱（3.0和4.5微克/分钟/分升组织容积）诱导的前臂血流累积变化显著低于正常对照组（分别为10.1±8.0毫升/分钟/100毫升与20.4±11.7毫升/分钟/100毫升组织容积；p<0.01）。在心力衰竭患者中，虽然观察到乙酰胆碱诱导的前臂血流变化与峰值摄氧量（r=0.53，p<0.05）和通气阈值（r=0.42，p<0.05）呈显著正相关，但与年龄、性别、症状持续时间、住院时间或静息血流动力学参数之间未发现显著关系。这些观察结果表明，内皮依赖性外周血管舒张功能受损可能是导致慢性心力衰竭患者运动不耐受的因素之一，这可能是由于其在运动期间对营养性骨骼肌血流产生限制作用所致。
