Mangiafico R A, Malatino L S, Spada R S, Santonocito M
Clinica Medica L. Condorelli Università di Catania, Azienda Ospedali V. Emanuele, Ferrarotto e S. Bambino Catania, Italy.
Panminerva Med. 1996 Dec;38(4):229-33.
The present study was designed to examine the role of endothelin-1 (ET-1), an endothelium-derived potent long-acting vasoconstrictor peptide, in vascular acrosyndromes with hypersensitivity to cold. Plasma ET-1 concentration was measured, before and after cold test, in 12 subjects with "a frigore" vascular acrosyndromes (9 females and 3 males, age range 17-59 years), of whom 6 were with primary Raynaud's phenomenon and 6 with essential acrocyanosis, and in 6 controls (5 females and 1 male, age range 21-37 years). Cold stimulation was performed by immersion of one hand into a water bath at 13 degrees C for 5 minutes. Blood samples were simultaneously drawn from an antecubital vein in the cooled side and in the contralateral arm at baseline, at the stop of cooling, at 10 and 90 minutes from the beginning of the cold challenge. Mean (+/-SD) baseline ET-1 plasma levels, as measured by radioimmunoassay, were higher in patients with "a frigore" vascular acrosyndromes (4.8 +/- 0.3 pmol/l) than in control subjects (1.9 +/- 0.1 pmol/l, p < 0.001). After hand cooling ET-1 rose in patients with "a frigore" vascular disorders to a peak value of 7.0 +/- 0.4 pmol/l, which was much greater than that observed in healthy subjects (2.7 +/- 0.4 pmol/l, p < 0.001). Absolute increase in ET-1 plasma concentrations from baseline to peak value was significantly higher in patients with "a frigore" vascular acrosyndromes than in normal subjects (2.2 +/- 0.3 vs 0.8 +/- 0.2 pmol/l, p < 0.001), being only in the former group the rise in ET-1 still detected 90 minutes after cold test. Plasma levels of ET-1 in the controlateral arm raised in a similar fashion, but absolute values were lower than in cooled arm. Circulating ET-1 levels in patients with primary Raynaud's phenomenon and essential acrocyanosis showed a similar pattern during the study. Our data demonstrate that in patients with "a frigore" vascular acrosyndromes baseline and cold-stimulated plasma ET-1 concentrations are increased. Further, in these vascular disorders, exaggerated ET-1 response to cold is prolonged. These findings suggest that increased ET-1 may contribute to an imbalance between vasoactive mediators in the cutaneous blood vessels contributing to the abnormal vasoconstriction to cold in these disorders. Alternatively, the increment in ET-1 release may represent a marker for endothelial cell damage in "a frigore" vascular acrosyndromes.
本研究旨在探讨内皮素 -1（ET -1），一种内皮源性强效长效血管收缩肽，在对寒冷过敏的血管性肢端综合征中的作用。在12例患有“寒冷性”血管性肢端综合征（9例女性和3例男性，年龄范围17 - 59岁）的受试者中，于冷试验前后测量血浆ET -1浓度，其中6例患有原发性雷诺现象，6例患有原发性肢端发绀症，同时选取6例对照者（5例女性和1例男性,年龄范围21 - 37岁）进行测量。通过将一只手浸入13摄氏度的水浴中5分钟来进行冷刺激。在基线、冷却停止时、冷刺激开始后10分钟和90分钟，同时从冷却侧的肘前静脉和对侧手臂采集血样。通过放射免疫测定法测得，“寒冷性”血管性肢端综合征患者的平均（±标准差）基线ET -1血浆水平（4.8±0.3 pmol / l）高于对照者（1.9±0.1 pmol / l，p <0.001）。手部冷却后，“寒冷性”血管疾病患者的ET -1升高至峰值7.0±0.4 pmol / l，这远高于健康受试者中观察到的峰值（2.7±0.4 pmol / l，p <0.001）。“寒冷性”血管性肢端综合征患者从基线到峰值的ET -1血浆浓度绝对增加值显著高于正常受试者（2.2±0.3 vs 0.8±0.2 pmol / l，p <0.001），仅在前者组中，冷试验90分钟后仍能检测到ET -1的升高。对侧手臂的ET -1血浆水平以类似方式升高，但绝对值低于冷却手臂。在研究过程中，原发性雷诺现象和原发性肢端发绀症患者的循环ET -1水平呈现相似模式。我们的数据表明，在“寒冷性”血管性肢端综合征患者中，基线和冷刺激后的血浆ET -1浓度均升高。此外，在这些血管疾病中，ET -1对寒冷的过度反应会持续延长。这些发现表明，ET -1升高可能导致皮肤血管中血管活性介质之间的失衡，从而导致这些疾病中对寒冷的异常血管收缩。或者，ET -1释放的增加可能代表“寒冷性”血管性肢端综合征中内皮细胞损伤的一个标志物。
