Andreassen A K, Gullestad L, Holm T, Simonsen S, Kvernebo K
Department of Cardiology, Rikshospitalet, Oslo, Norway.
Clin Transplant. 1998 Aug;12(4):324-32.
Patients with heart failure demonstrate attenuated endothelium-dependent vasodilation of the peripheral circulation, while this is suggested to be reversed after heart transplantation. However, data from human subjects are limited and conflict with studies on the peripheral vasomotor tone in cyclosporine-treated animals, suggesting endothelial dysfunction. We recorded forearm skin perfusion responses following graded iontophoresis of 1% acetylcholine (endothelium-dependent) and 1% sodium nitroprusside (endothelium-independent) by laser Doppler perfusion measurements in 32 heart transplant recipients and 15 age-matched controls. In addition, the hyperemic response to 3 min of blood flow occlusion to the forearm was measured on the third finger pulp. With comparable baseline values, the increases in perfusion to the 4 applications of acetylcholine were significantly attenuated in heart transplant recipients compared with controls: 59 +/- 9 vs. 146 +/- 32, 242 +/- 39 vs. 492 +/- 77, 480 +/- 66 vs. 845 +/- 120 and 699 +/- 77 vs. 993 +/- 139% (mean +/- SEM; all p < 0.01). Peak hyperemia (134 +/- 4 vs. 153 +/- 12 arbitrary units (AU); p < 0.05)), time for the hyperemic perfusion to return to preocclusive baseline (52.4 vs. 102.9 s; p < 0.01) and hence the area under the perfusion curve (1469 +/- 244 vs. 4581 +/- 921 AU s; p < 0.01) were reduced among heart transplant recipients. The area under the perfusion curve correlated significantly with mean arterial blood pressure (r = -0.60; p < 0.01) and with the responses to iontophoresis of acetylcholine (r = 0.41; p < 0.01). Two non-invasive tests of vascular function demonstrate attenuated endothelial-dependent microvascular responses in heart transplant recipients. The relative impact of prior congestive heart failure and postoperative factors, such as treatment with cyclosporine, remains to be determined.
心力衰竭患者表现出外周循环中内皮依赖性血管舒张功能减弱，而心脏移植后这种情况被认为会逆转。然而，来自人类受试者的数据有限，且与环孢素治疗动物的外周血管运动张力研究结果相矛盾，提示存在内皮功能障碍。我们通过激光多普勒血流测量法记录了32名心脏移植受者和15名年龄匹配的对照者在1%乙酰胆碱（内皮依赖性）和1%硝普钠（非内皮依赖性）梯度离子导入后的前臂皮肤灌注反应。此外，还测量了第三指腹在前臂血流阻断3分钟后的充血反应。在基线值相当的情况下，与对照组相比，心脏移植受者在4次应用乙酰胆碱后灌注增加明显减弱：分别为59±9与146±32、242±39与492±77、480±66与845±120以及699±77与993±139%（平均值±标准误；均p<0.01）。心脏移植受者的充血峰值（134±4与153±12任意单位（AU）；p<0.05）、充血灌注恢复到阻断前基线的时间（52.4与102.9秒；p<0.01）以及因此的灌注曲线下面积（1469±244与4581±921 AU·s；p<0.01）均降低。灌注曲线下面积与平均动脉血压显著相关（r=-0.60；p<0.01），与乙酰胆碱离子导入反应也显著相关（r=0.41；p<0.01）。两项血管功能的非侵入性测试表明，心脏移植受者的内皮依赖性微血管反应减弱。既往充血性心力衰竭和术后因素（如环孢素治疗）的相对影响仍有待确定。
