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背景:血管内皮功能失调是动脉粥样硬化的最初事件,目前评价血管内皮功能的方法较多,但适用于临床推广的方法较少。目的:观察老年周围动脉疾病患者肱动脉及股浅动脉内皮依赖性舒张功能和硝酸甘油介导的非内皮依赖性舒张功能,探讨上下肢动脉舒张功能相关性及特点。设计、时间和地点:非随机化同期对照实验,于2000-10/2002-05在解放军总医院老年心内科完成。对象:选择2000-10/2002-05解放军总医院住院的周围动脉疾病患者33例作为周围动脉疾病组,男27例,女6例,年龄(79±6)岁。均经超声多普勒检查下肢动脉一处以上动脉硬化斑块凸起及管腔狭窄≥50%,且年龄≥60岁。选择同期本院门诊进行健康体检的离退休干部40例作为健康对照组,均为符合中华医学会老年医学学会1995年对健康老人标准的建议。选择本院同期有冠状动脉硬化性心脏病及其危险因素并除外周围动脉疾病的患者30例为心血管危险因素组。方法:采用无创的方法应用美国通用电器公司生产的Logiq500型高分辨率彩色多普勒超声诊断系统检测纳入对象的肱动脉及股浅动脉的基础管径,然后阻断该动脉的血流并重新恢复血流后再次检测血管内径,评价其内皮依赖性舒张功能。检测肢体动脉基础内径后,舌下含服硝酸甘油片0.6mg导致血管扩张,以前后两次之差代表该动脉的非内皮依赖性舒张程度。主要观察指标:3组肢体动脉的内皮依赖性舒张功能及非内皮依赖性舒张功能。结果:周围动脉疾病组患者肱动脉的内皮依赖性舒张程度和非内皮依赖性舒张程度与股浅动脉的内皮依赖性舒张程度和非内皮依赖性舒张程度均明显低于健康对照组和心血管危险因素组,差异有显著性意义(t=-11.82～10.91,P<005)。周围动脉疾病组患者股浅动脉的内皮依赖性舒张程度和非内皮依赖性舒张程度明显低于肱动脉,差异有显著性意义(t=3.535,3.135,P<0.01);股浅动脉的内皮依赖性舒张程度和非内皮依赖性舒张程度与肱动脉的相关性好(r=0.9314,0.9191,P<0.01)。结论:股浅动脉的内皮依赖性舒张功能及非内皮依赖性舒张功能能更敏感、更直接地反映老年周围动脉疾病患者的血管反应性。股浅动脉与肱动脉相关性好。
BACKGROUND: Vascular endothelial dysfunction is the initial event of atherosclerosis. At present, there are many methods to evaluate the function of vascular endothelial cells, but few methods are available for clinical application. Objective: To observe the endothelium-dependent vasodilation of brachial artery and superficial femoral artery and the non-endothelium-dependent vasodilatation mediated by nitroglycerin in elderly patients with peripheral arterial disease and to explore the correlation and characteristics of diastolic function of upper and lower extremity arteries. DESIGN, TIME AND SETTING: The nonrandomized concurrent control trial was performed at the Department of Geriatric Cardiology, People’s Liberation Army General Hospital from October 2000 to May 2002. PARTICIPANTS: Thirty-three patients with peripheral arterial disease hospitalized in People’s Liberation Army General Hospital from 2000-10 / 2002-05 were selected as peripheral arterial disease group. There were 27 males and 6 females, aged 79 ± 6 years. Ultrasound Doppler examination of lower extremity artery more than one atherosclerotic plaque bulging and stenosis ≥ 50%, and the age ≥ 60 years. Select the same period our hospital out-patient health examination 40 cases of retired cadres as a healthy control group, are in line with the Chinese Medical Association Geriatrics Society in 1995 recommended the criteria for healthy elderly. 30 patients with coronary heart disease and its risk factors and peripheral arterial disease were selected as cardiovascular risk factors in our hospital at the same period. Methods: The noninvasive method was used to detect the basic diameter of brachial and superficial arteries in Logiq500 high resolution color Doppler ultrasound system manufactured by General Electric Company, and then the blood flow of the artery was blocked and re-established Vascular diameter was restored after blood flow was recovered, and endothelium-dependent diastolic function was evaluated. After detecting the basic diameter of limb artery, sublingual nitroglycerin 0.6mg tablets lead to vasodilatation, before and after the difference between the two represents the endothelium-independent endothelium-dependent relaxation. MAIN OUTCOME MEASURES: Endothelium-dependent vasodilation and non-endothelium-dependent vasodilation of limb arteries in three groups. Results: Endothelium-dependent relaxation and non-endothelium-dependent relaxation of the brachial artery in patients with peripheral arterial disease were significantly lower than those in the control and cardiovascular risk groups, as compared with the endothelium-dependent relaxation and non-endothelium-dependent relaxation in the superficial femoral artery Factor group, the difference was significant (t = -11.82 ~ 10.91, P <005). Endothelium-dependent relaxation and non-endothelium-dependent relaxation of the superficial femoral artery in patients with peripheral arterial disease were significantly lower than those in the brachial artery (t = 3.535, 3.135, P <0.01) The correlation between sexual relaxation and non-endothelium-dependent relaxation was well correlated with brachial artery (r = 0.9314,0.9191, P <0.01). CONCLUSION: Endothelium-dependent and non-endothelium-dependent diastolic function of the superficial femoral artery can be more sensitive and more directly reflect the vascular reactivity in elderly patients with peripheral arterial disease. Superficial femoral artery and brachial artery correlation.