间歇性跛行合并冠心病患者下肢皮肤微血管床作为其心肌微循环的可能模型

A. Vasiljev, N. Streltsova, I. Bessonov, G. Kolunin
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引用次数: 0

摘要

目的:探讨用激光多普勒血流仪推断闭塞性动脉粥样硬化患者下肢皮肤微血管床检查结果作为冠心病患者心肌微循环模型的可能性。材料和方法。研究对象为经血管造影证实患有冠心病的男性(70例)和下肢动脉粥样硬化闭塞的男性(74例)。应用激光多普勒血流仪检测冠心病患者左前臂Zakharyin - Head区皮肤微循环和下肢动脉闭塞性动脉粥样硬化患者患肢足部皮肤微循环。基础血流、振幅频谱、肌源性、神经源性血管张力和闭塞参数也被评估。对照组包括50名实际健康的男性冠心病患者和20名男性下肢动脉闭塞性动脉粥样硬化患者。患者在初始阶段和血管内心肌及下肢血流恢复后2-3周进行检查。结果和讨论。在初始研究阶段,冠心病和下肢动脉粥样硬化患者的微循环图像与健康个体不同,其变化覆盖微血管床的所有环节,并以毛细血管前段收缩为特征,毛细血管血流中值分别下降17.5%和43.1%,微血管血流储备中值分别下降11.2%和31.0%,具有统计学意义。同时动脉静脉旁路手术也增加了10.3%和70.8%。闭塞性动脉粥样硬化患者下肢血流恢复后,肌肉疼痛消失,踝肩指数恢复正常。同时,可以观察到毛细血管血流增加(+ 13.6%),微血管床储备电位增加(+ 20.6%),同时毛细血管前段血管张力降低(- 15.1%),血液旁路指数降低(- 25.0%)。冠心病患者冠状动脉成形术后临床表现较好,同时微血管床呈相似且单向的阳性变化趋势。冠心病的发病机制和临床表现与下肢动脉闭塞性动脉粥样硬化有很多共同之处,且这些患者血管成形术前后前臂和足部皮肤的微循环变化是单向的,这些都提示冠心病患者心肌微循环系统的变化是相似的。因此,它开启了在微血管水平上有针对性的药物影响的可能性。
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The microvascular bed of the skin of lower limbs in patients with intermittent lameness and coronary heart disease as a possible model of their myocardial microcirculation
Purpose: to assess possibility to extrapolate findings of skin microvascular bed examination in lower extremities with laser Doppler flowmetry in patients with obliterating atherosclerosis as a model of their myocardial microcirculation in coronary heart disease.Material and methods. Males with angiographically confirmed coronary heart disease (n = 70) and obliterating atherosclerosis in lower limbarteries (n = 74) were taken in the study. Microcirculation of the skin in the left forearm in the Zakharyin – Head zone in patients with coronaryheart disease and skin microcirculation in the foot of affected limb in patients with obliterating atherosclerosis of arteries of lower extremities were examined with laser Doppler flowmetry. The basal blood flow, amplitude-frequency spectrum of its oscillations, myogenic, neurogenic vascular tone and occlusion parameters were assessed as well. Comparison groups included 50 practically healthy males for the patients with coronary heart disease and 20 males – for the patients with obliterating atherosclerosis of arteries of lower extremities. Patients were examinedat the initial stage and in 2–3 weeks after endovascular restoration of blood flow in the myocardium and lower limbs.Results and discussion. At the initial research stage, the microcirculation picture in patients with coronary heart disease and obliterating ath-erosclerosis in lower extremities differed from that of healthy individuals by shifts covering all links of the microvascular bed and characterizedby constriction of the precapillary segment, a statistically significant decrease in median values of capillary blood flow by 17.5 and 43.1 %,microvascular blood flow reserve – by 11.2 and 31.0 %, as well as by the increase in arteriolovenular blood bypass – by 10.3 and 70.8 %,respectively. After the restoration of blood flow in lower extremities in patients with obliterating atherosclerosis, muscular pain disappeared,and the ankle-shoulder index got normalized. At the same time, one could observe a statistically significant increase in the capillary blood flow(+13.6 %), the increase of reserve potential in microvascular bed (+20.6 %) with the simultaneous decrease of vascular tone in the precapillarysegment (–15.1 %) and of the blood bypass index (–25.0 %). Better clinical picture after coronary angioplasty in patients with coronary heart disease was accompanied with a similar and unidirectional tendency to positive changes in the microvascular bed.Conclusion. As far as etiopathogenetic mechanisms and clinical manifestations of coronary heart disease and obliterating atherosclerosis in arteries of lower extremities have much in common and microcirculatory shifts in forearm and foot skin in these patients before and after angioplasty are unidirectional, all these allow to suggest that one can see similar changes in the myocardium microcirculatory system in patients with coronary heart disease. Thus, it opens possibilities to have a targeted medicamentous impact at the microvascular level.
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期刊介绍: The main columns of "Chinese Journal of Laser Medicine & Surgery" include treatises, which report the latest research results in basic research and clinical trials in the field of laser medicine; comprehensive reviews of the latest research progress in laser medicine at home and abroad. In addition, there are short reports and excerpts from foreign journals, conference news and other columns. The journal has published a large number of papers on basic research on laser medicine and applied research in various clinical subjects, aiming to play a positive role in promoting the application of laser in medicine and improving the level of laser medicine research.
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