这项工作是由Grant的奖数R01HL096593和K23HL72825从国家心脏，肺和血液研究所的支持。的内容是纯粹的托马斯杰斐逊大学的责任，并不一定代表国家心脏，肺和血液研究所和美国国立卫生研究院的官方意见。

病例报告 （如适用）:不适用，这仍然是一个实验的研究过程，尚未应用于临床。 诊断，评估和计划 （必填，如果适用）:不适用，这仍然是一个实验的研究过程，尚未应用于临床。 过程 （必填）:这部分应包括有关程序一步一步的描述，下面的指导方针。 1。毛细管显微镜（ 图1） <ol><li>我们的甲襞微循环技术被改编从Serne和他的同事们1。在此过程中的排除标准是胶原血管疾病，，因为胶原血管疾病称为毛细管变化。 </li><li>至少10小时通宵速度快，20分钟层次的休息，微血管的测量进行了一个半小时，在7上午11时，在一个安静的温控室（保持在21.5-22.5°C之间），在心脏水平的坐姿，左手的主题。 </li><li>甲襞毛细血管中的第三个手指背皮肤是采用体视显微镜（奥林巴斯中心谷，PA），与4万像素的的SPOT洞察单色数码相机（型号IN-1400:诊断仪器;斯特林高地，MI），和一台笔记本电脑（戴尔Latitude D600戴尔奥斯汀，德克萨斯州）。要限制运动，左手和前臂松散地覆盖有一个折叠的毯子，并搁在显微镜的基础上定位在另一个折起的毯子。 </li><li>甲床照明是实现一个250-W卤素光纤光纤灯（KL 2500LCD:肖特-Fostec艾姆斯佛德，纽约）;额外照明的补充150W光纤光缆卤素光源（B＆B显微镜有限公司，Warrendale，PA）的使用在深色个人。 </li><li>可视化的毛细血管，使用3.2倍物镜​​（奥林巴斯3.2/0.07）与系统总放大倍数为38.4x。 </li><li>使用相同的标准SPOT软件功能（拉伸光明和黑暗的水平），以最大限度地提高知名度的毛细血管，在所有科目使用SPOT成像相机随附的软件在毛细管的照片，光/暗对比度增强。 </li><li>量化毛细血管密度，数字显微照片，每3-5秒在每个分三个阶段，在休息的基线，在闭塞后反应性充血，并在静脉闭塞。 （一）在休息基线，显微检测毛细血管灌注在休息三分钟的时间内，被接管。 （b）在闭塞后反应性充血，显微采取量化功能灌注的毛细血管（基线加上储备毛细血管），如下所示。首先，左上臂的遮挡扎口膨胀收缩压为10分钟以上至40毫米汞柱。显微照片，然后在第E首先分钟后立即释放所有功能灌注的毛细血管动脉闭塞，可视化。反应性充血的毛细血管密度显示功能受损毛细血管招聘，和因此功能稀薄。 （c）在静脉闭塞显微照片采取量化最大的毛细血管密度，其中既包括灌注（活性红血细胞（RBC）的运动）和未注满（充满停滞，非移动的红细胞）毛细血管3如下。经过10分钟的休息后，闭塞后反应性充血过程，手臂袖口膨胀到60毫米汞柱，持续60秒，被动地迫使血液进入所有专利毛细血管目前，在这段时间内采取显微照片。由于毛细血管密度最大，包括所有的毛细血管结构，减少毛细血管密度最大表示结构疏松。 </li><li>毛细血管密度被定义为每平方密耳的毛细血管的数目limeter甲襞的皮肤，并且被计算为四个测量值的平均值，得到的四个最清晰的图像，至少扭曲运动。在我们的研究中，已被用于毛细管计数的典型值（毛细血管个/ mm 2）55-80为基线，65-90的局部缺血后，和90-105静脉闭塞。 ％毛细管征聘的值通常是在5％和25％（平均〜10-15％）之间，和％灌注毛细管之间的70％和95％（意思〜80-90％），其值较低，比正常血压的高血压。三个观察员进行独立评估的10个不同主题的照片（ 图2）手动计数过程的重现性得到了验证。观察员的身份和血压这些科目被蒙蔽。后来独立进行的计数培训，表现出高度认同。平均评分和评分间差异的奥德r的2-3毛细血管/月2，组内相关系数均大于0.90。短期的甲襞微循环变化的措施的评分和评分间差异的同一量级（约2毛细血管/毫米2），但观察到2-3年的长期的变化是一个数量级更大的（约15毛细管/毫米2），表明纵向变化，可以容易地区别于评价者变化。的毛细作用的措施的可靠性也高（组内相关系数为0.84，％的毛细招聘和0.82％的灌注毛细血管）。 </li><li>调查人员现在利用以计算机为基础的方法量化毛细血管密度使用Image-Pro Plus的成像软件（版本6.2，Media Cybernetics公司，马里兰州贝塞斯达， 图3）。基线，缺血后，和肝静脉之间的Pearson相关我们充血计数完成10个科目的软件和相应的手动计数分别为0.78，0.78和0.71​​（P &lt;0.05），表明两种方法之间的合理的协议。基于计算机的计数的可靠性是略低于手动计数，但仍处于高位（组内相关系数= 0.91为基准，静脉闭塞缺血后0.86和0.84）。我们有未公布的数据也证明了该协会的自动计数与多种心血管危险因素，包括高血压，这是我们目前正在准备出版。 </li><li> 表1总结了毛细血管密度的测定和计算。除以毛细血管密度的增加引起的闭塞后反应性充血（闭塞后反应性充血的毛细血管密度，减去基线毛细血管密度），的毛细血管密度最大的（无源静脉观察毛细管招聘百分比进行评估我们阻塞）。百分比灌注毛细血管代表所有的毛细血管目前，灌注功能活跃，比​​例的计算方法是将闭塞后反应性充血的毛细血管密度最大的毛细血管密度。两者％的毛细管招聘和百分之灌注毛细血管反映毛细血管功能。较低的值对这些措施表示功能的毛细管稀疏。 </li></ol> 2。血管内皮功能的评估<ol><li>血管内皮功能的评估之前和之后闭塞后的反应性充血，使用非侵入性的体积描记法测量前臂的血流量，根据该方法，4 Sivertsson利用内皮依赖性的刺激诱 ​​导的血管舒张反应性充血。 </li><li>平卧休息10分钟后，在坐姿的主题，水银的橡胶应变计拉长到10％，超出了它的休息长度的循环around为主体的前臂5厘米以下的肘前窝。 </li><li>应变计连接到一个体积描记器（EC-4:DE霍坎森公司;贝尔维尤，WA），而这又是连接到多普勒记录（CW-1，DE霍坎森公司; Belleveue，WA）。 </li><li>上臂闭塞袖口，和手臂被暂停使用吊​​带绷带连接到一个可调节的静脉极舒适心脏水平。收缩压和舒张压血压和心脏率DINAMAP特全公司的100自动BP袖口（GE Healthcare公司，新泽西州Piscataway，）放置在相反的手臂。 </li><li>儿科袖带膨胀到200毫米汞柱堵塞流的手绕在手腕上。上臂袖带充气至50毫米汞柱，瘪1.5秒，然后迅速重新充气之前每个前臂血流量的测量，通过扩展的应变计对周围的前臂下得到。 </li><li>前臂血流量（FBF）休息基线（FBF 基地 ）和一个测量吨闭塞后充血引起的最大血管舒张（FBF 最大 ）。对于基线血流量测量，连续四个FBF曲线是在30秒内（FBF 基地 ）。 </li><li>的遮挡扎口，然后膨胀，收缩压为10分钟以上至40毫米汞柱。释放后动脉闭塞（闭塞后反应性充血），在第一个30秒的流量（FBF 最大 ）四个连续的的FBF曲线获得。 </li><li>计算的比率FBF 最高 / FBF 碱作为血管舒张的估计值，由四个FBF 基值的平均值除以四个FBF max值的平均值。5前臂血管阻力在最大血管舒张（FVR 最大 ）被计算为平均动脉压（MAP）除以FBF 最大 。 :FBF 最大反应性充血时被直接有关FBF最大输注动脉内乙酰胆碱后，内皮依赖性的血管扩张剂。6 </sup&gt;的因此，FBF max和比FBF 最大 / FBF 基地的被接受的非侵入性的血管内皮功能的措施。6-8此外，FBF max和FVR 最大反映电阻动脉的结构变化（增加壁/管腔比）的9 </li></ol>

<ol>
	<li>Serne, E. H., Gans, R. O., ter Maaten, J. C., ter Wee, P. M., Donker, A. J., Stehouwer, C. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Capillary+recruitment+is+impaired+in+essential+hypertension+and+relates+to+insulin's+metabolic+and+vascular+actions.">Capillary recruitment is impaired in essential hypertension and relates to insulin's metabolic and vascular actions.</a> Cardiovasc. Res. 49, 161-168 (2001).</li><li>Bollinger, A., Fagrell, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Clinical Capillaroscopy: A guide to its use in clinical research and practice. , (1990).</li><li>Antonios, T. F., Rattray, F. E., Singer, D. R., Markandu, N. D., Mortimer, P. S., MacGregor, G. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Maximization+of+skin+capillaries+during+intravital+video-microscopy+in+essential+hypertension:+comparison+between+venous+congestion,+reactive+hyperaemia+and+core+heat+load+tests.">Maximization of skin capillaries during intravital video-microscopy in essential hypertension: comparison between venous congestion, reactive hyperaemia and core heat load tests.</a> Clin. Sci. (Lond). 97, 523-528 (1999).</li><li>Sivertsson, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+hemodynamic+importance+of+structural+vascular+changes+in+essential+hypertension.">The hemodynamic importance of structural vascular changes in essential hypertension.</a> Acta. Physiol. Scand. Suppl. 343, 1-56 (1970).</li><li>Raitakari, O. T., Celermajer, D. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Testing+for+endothelial+dysfunction.">Testing for endothelial dysfunction.</a> Ann. Med. 32, 293-304 (2000).</li><li>Tousoulis, D., Antoniades, C., Stefanadis, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Evaluating+endothelial+function+in+humans:+a+guide+to+invasive+and+non-invasive+techniques.">Evaluating endothelial function in humans: a guide to invasive and non-invasive techniques.</a> Heart. 91, 553-558 (2005).</li><li>Higashi, Y., Sasaki, S., Nakagawa, K., Matsuura, H., Kajiyama, G., Oshima, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+noninvasive+measurement+of+reactive+hyperemia+that+can+be+used+to+assess+resistance+artery+endothelial+function+in+humans.">A noninvasive measurement of reactive hyperemia that can be used to assess resistance artery endothelial function in humans.</a> Am. J. Cardiol. 87, 121-125 (2001).</li><li>Higashi, Y., Yoshizumi, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=New+methods+to+evaluate+endothelial+function:+method+for+assessingendothelial+function+in+humans+using+a+strain-gauge+plethysmography:+nitric+oxide-dependent+and+independent+vasodilation.">New methods to evaluate endothelial function: method for assessingendothelial function in humans using a strain-gauge plethysmography: nitric oxide-dependent and independent vasodilation.</a> J. Pharmacol. Sci. 93, 399-404 (2003).</li><li>Lind, L., Sarabi, M., Millgard, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Methodological+aspects+of+the+evaluation+of+endothelium+dependent+vasodilatation+in+the+human+forearm.">Methodological aspects of the evaluation of endothelium dependent vasodilatation in the human forearm.</a> Clin. Physiol. 18, 81-87 (1998).</li><li>Cheng, C., Diamond, J. J., Falkner, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+capillary+rarefaction+in+mild+blood+pressure+elevation.">Functional capillary rarefaction in mild blood pressure elevation.</a> Clinical and Translational Science. 1, 75-79 (2008).</li><li>Cheng, C., Daskalakis, C., Falkner, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Capillary+rarefaction+in+treated+and+untreated+hypertensive+subjects.">Capillary rarefaction in treated and untreated hypertensive subjects.</a> Therapeutic Advances in Cardiovascular Disease. 2, 79-88 (2008).</li><li>Antonios, T. F., Singer, D. R., Markandu, N. D., Mortimer, P. S., MacGregor, G. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rarefaction+of+skin+capillaries+in+borderline+essential+hypertension+suggests+an+early+structural+abnormality.">Rarefaction of skin capillaries in borderline essential hypertension suggests an early structural abnormality.</a> Hypertension. 34, 655-658 (1999).</li><li>Noon, J. P., Walker, B. R., Webb, D. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impaired+microvascular+dilatation+and+capillary+rarefaction+in+young+adults+with+a+predisposition+to+high+blood+pressure.">Impaired microvascular dilatation and capillary rarefaction in young adults with a predisposition to high blood pressure.</a> J. Clin. Invest. 99, 1873-1879 (1997).</li><li>Antonios, T. F., Rattray, F. M., Singer, D. R., Markandu, N. D., Mortimer, P. S., MacGregor, G. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rarefaction+of+skin+capillaries+in+normotensive+offspring+of+individuals+with+essential+hypertension.">Rarefaction of skin capillaries in normotensive offspring of individuals with essential hypertension.</a> Heart. 89, 175-178 (2003).</li><li>de Jongh, R. T., Ijzerman, R. G., Serne, E. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Visceral+and+truncal+subcutaneous+adipose+tissue+are+associated+with+impaired+capillary+recruitment+in+healthy+individuals.">Visceral and truncal subcutaneous adipose tissue are associated with impaired capillary recruitment in healthy individuals.</a> J. Clin. Endocrinol. Metab. 91, 5100-5106 (2006).</li><li>de Jongh, R. T., Serne, E. H., Ijzerman, R. G., de Vries, G., Stehouwer, C. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Free+fatty+acid+levels+modulate+microvascular+function:+relevance+for+obesity-associated+insulin+resistance,+hypertension,+and+microangiopathy.">Free fatty acid levels modulate microvascular function: relevance for obesity-associated insulin resistance, hypertension, and microangiopathy.</a> Diabetes. 53, 2873-2882 (2004).</li><li>de Jongh, R. T., Serne, E. H., RG, I. J., Stehouwer, C. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microvascular+function:+a+potential+link+betweensalt+sensitivity,+insulin+resistance+and+hypertension.">Microvascular function: a potential link betweensalt sensitivity, insulin resistance and hypertension.</a> J. Hypertens. 25, 1887-1893 (2007).</li><li>Ijzerman, R. G., Voordouw, J. J., Van Weissenbruch, M. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=TNF-alpha+levels+are+associated+withskin+capillary+recruitment+in+humans:+a+potential+explanation+for+the+relationship+between+TNF-alpha+and+insulin+resistance.">TNF-alpha levels are associated withskin capillary recruitment in humans: a potential explanation for the relationship between TNF-alpha and insulin resistance.</a> Clin. Sci. (Lond). 110, 361-368 (2006).</li><li>Yvonne-Tee, G. B., Rasool, A. H., Halim, A. S., Rahman, A. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Noninvasive+assessment+of+cutaneous+vascular+function+in+vivo+using+capillaroscopy,+plethysmography+and+laser-Doppler+instruments:+its+strengths+and+weaknesses.">Noninvasive assessment of cutaneous vascular function in vivo using capillaroscopy, plethysmography and laser-Doppler instruments: its strengths and weaknesses.</a> Clin. Hemorheol. Microcirc. 34, 457-473 (2006).</li><li>Wilkinson, I. B., Webb, D. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Venous+occlusion+plethysmography+in+cardiovascular+research:+methodology+and+clinical+applications.">Venous occlusion plethysmography in cardiovascular research: methodology and clinical applications.</a> Br. J. Clin. Pharmacol. 52, 631-646 (2001).</li><li>Thijssen, D. H., Bleeker, M. W., Smits, P., Hopman, M. T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reproducibility+of+blood+flow+and+post-occlusive+reactive+hyperaemia+as+measured+by+venous+occlusion+plethysmography.">Reproducibility of blood flow and post-occlusive reactive hyperaemia as measured by venous occlusion plethysmography.</a> Clin. Sci. (Lond). 108, 151-157 (2005).</li><li>Leslie, S. J., Attina, T., Hultsch, E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+two+plethysmography+systems+in+assessment+of+forearm+blood+flow.">Comparison of two plethysmography systems in assessment of forearm blood flow.</a> J. Appl. Physiol. 96, 1794-179 (2004).</li><li>James, M. A., Tullett, J., Hemsley, A. G., Shore, A. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+aging+and+hypertension+on+the+microcirculation.">Effects of aging and hypertension on the microcirculation.</a> Hypertension. 47, 968-9674 (2006).</li><li>Debbabi, H., Uzan, L., Mourad, J. J., Safar, M., Levy, B. I., Tibirica, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Increased+skin+capillary+density+in+treated+essential+hypertensive+patients.">Increased skin capillary density in treated essential hypertensive patients.</a> Am. J. Hypertens. 19, 477-483 (2006).</li><li>Serne, E. H., Gans, R. O., ter Maaten, J. C., Tangelder, G. J., Donker, A. J., Stehouwer, C. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impaired+skincapillary+recruitment+in+essential+hypertension+is+caused+by+both+functional+and+structural+capillary+rarefaction.">Impaired skincapillary recruitment in essential hypertension is caused by both functional and structural capillary rarefaction.</a> Hypertension. 38, 238-242 (2001).</li><li>Carpentier, P. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=New+techniques+for+clinical+assessment+of+the+peripheral+microcirculation.">New techniques for clinical assessment of the peripheral microcirculation.</a> Drugs. 58, 17-22 (2001).</li><li>Shore, A. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Capillaroscopy+and+the+measurement+of+capillary+pressure.">Capillaroscopy and the measurement of capillary pressure.</a> Br. J. Clin. Pharmacol. 50, 501-513 (2000).</li></ol>

没有透露这项工作的行为或发布相关的经济利益冲突。

毛细管显微镜（毛细血管显微镜）的毛细管结构是一个非标准的措施。然而，目前有没有为直接毛细管structure.Furthermore评估的标准方法，毛细血管显微镜已被广泛用于直接评价capillarydensity发表的作品，12日，13日，10日，11日，14日至18日在大，越来越多的。此外，我们已经证实了的毛细血管显微镜技术的关联甲襞微循环的研究结果与前臂血流，血管功能的一个行之有效的措施，10日，11?...

non-invasive assessment of microvascular and endothelial function

作者们利用甲襞微循环和前臂血流技术调查的微血管功能障碍在心血管疾病的发病机制中的作用。毛细管显微镜是一种非侵入性的，相对廉价的直接可视化的微循环的方法。毛细管招聘百分比评估，将毛细血管密度的增加引起的闭塞后反应性充血（闭塞后反应性充血毛细血管密度减去基线毛细血管密度），最大毛细血管密度（被动静脉阻塞的过程中观察到的）。百分比灌注毛细血管代表所有的毛细血管目前，灌注功能活跃，比​​例的计算方法是将闭塞后反应性充血的毛细血管密度最大的毛细血管密度。两者％的毛细管招聘和百分之灌注毛细血管反映毛细血管功能。前臂血流（FBF）技术公关ovides接受血管内皮功能的非侵入性的措施:该比率FBF 最高 / FBF 碱作为血管舒张的估计值，计算除以四个FBF由四个FBF 基值的平均值的最大值的平均值。前臂血管阻力最大的血管扩张（FVR 最大值 ）计算的平均动脉压（MAP）除以FBF 最大 。甲襞微循环和前臂技术，易于接受的患者，可以学得很快。 的微血管和内皮细胞的功能，使用本文介绍的方法可能有未来效用在临床病人的心血管疾病的危险减贫战略措施。正如我们所发表的报告表明，微血管和内皮功能障碍被发现在初始阶段包括高血压前期，高血压，血管和内皮细胞功能的措施最终可能会有助于早期识别，终末期血管病变的危险分层和预防，其潜在的致命后果。

在血压正常和高血压个体之间的微血管的外观的差异是显而易见的，通过比较图4和图5。组织良好的行中的血压正常的个体中， 图4示出了典型的网络直毛细血管。相比之下， 图5显示了一个弄乱模式，皱缩，卷曲的毛细血管。 作者有持续的兴趣的微血管功能障碍在心血管疾病的发病机制中的作用。在他们的第一NIH / NHLBI资助?...

Watch this Scientific Journal Video about Non-invasive Assessment of Microvascular and Endothelial Function at JoVE.com

Non-invasive Assessment of Microvascular and Endothelial Function

毛细管显微镜是一种非侵入性的，相对廉价的直接可视化的微循环的方法。前臂血流技术提供接受血管内皮功能的非侵入性的措施。

非侵入性的评估微血管和内皮功能

The authors have utilized capillaroscopy and forearm blood flow techniques to investigate the role of microvascular dysfunction in pathogenesis of ...

non-invasive-assessment-of-microvascular-and-endothelial-function

Research

JoVE Journal

Medicine

16.1K 次观看.  Thomas Jefferson University. 毛细管显微镜是一种非侵入性的，相对廉价的直接可视化的微循环的方法。前臂血流技术提供接受血管内皮功能的非侵入性的措施。

视频: Non-invasive Assessment of Microvascular and Endothelial Function

Assessing Endothelial Vasodilator Function with the Endo-PAT 2000

The endothelium is a delicate monolayer of cells that lines all blood vessels, and which comprises the systemic and lymphatic capillaries. By virtue of the panoply of paracrine factors that it secretes, the endothelium regulates the contractile and proliferative state of the underlying vascular smooth muscle, as well as the interaction of the vessel wall with circulating blood elements. Because of its central role in mediating vessel tone and growth, its position as gateway to circulating immune cells, and its local regulation of hemostasis and coagulation, the the properly functioning endothelium is the key to cardiovascular health. Conversely, the earliest disorder in most vascular diseases is endothelial dysfunction.
In the arterial circulation, the healthy endothelium generally exerts a vasodilator influence on the vascular smooth muscle. There are a number of methods to assess endothelial vasodilator function. The Endo-PAT 2000 is a new device that is used to assess endothelial vasodilator function in a rapid and non-invasive fashion. Unlike the commonly used technique of duplex ultra-sonography to assess flow-mediated vasodilation, it is totally non-operator-dependent, and the equipment is an order of magnitude less expensive. The device records endothelium-mediated changes in the digital pulse waveform known as the PAT ( peripheral Arterial Tone) signal, measured with a pair of novel modified plethysmographic probes situated on the finger index of each hand. Endothelium-mediated changes in the PAT signal are elicited by creating a downstream hyperemic response. Hyperemia is induced by occluding blood flow through the brachial artery for 5 minutes using an inflatable cuff on one hand. The response to reactive hyperemia is calculated automatically by the system. A PAT ratio is created using the post and pre occlusion values. These values are normalized to measurements from the contra-lateral arm, which serves as control for non-endothelial dependent systemic effects. Most notably, this normalization controls for fluctuations in sympathetic nerve outflow that may induce changes in peripheral arterial tone that are superimposed on the hyperemic response.
In this video we demonstrate how to use the Endo-PAT 2000 to perform a clinically relevant assessment of endothelial vasodilator function.

A noninvasive procedure to assess endothelial function is demonstrated using the Endo-PAT 2000.

评估与远藤的PAT 2000内皮血管舒张功能

The endothelium is a delicate monolayer of cells that lines all blood vessels, and which comprises the systemic and lymphatic capillaries. By virtue of ...

科研

医学

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this is only partially explained by traditional CVD risk factors. Vascular dysfunction is an important non-traditional risk factor, characterized by vascular endothelial dysfunction (most commonly assessed as impaired endothelium-dependent dilation [EDD]) and stiffening of the large elastic arteries. While various techniques exist to assess EDD and large elastic artery stiffness, the most commonly used are brachial artery flow-mediated dilation (FMDBA) and aortic pulse-wave velocity (aPWV), respectively. Both of these noninvasive measures of vascular dysfunction are independent predictors of future cardiovascular events in patients with and without kidney disease. Patients with CKD demonstrate both impaired FMDBA, and increased aPWV. While the exact mechanisms by which vascular dysfunction develops in CKD are incompletely understood, increased oxidative stress and a subsequent reduction in nitric oxide (NO) bioavailability are important contributors. Cellular changes in oxidative stress can be assessed by collecting vascular endothelial cells from the antecubital vein and measuring protein expression of markers of oxidative stress using immunofluorescence. We provide here a discussion of these methods to measure FMDBA, aPWV, and vascular endothelial cell protein expression.

The degree of vascular dysfunction and contributing physiological mechanisms can be assessed in patients with chronic kidney disease by measuring brachial artery flow-mediated dilation, aortic pulse-wave velocity, and vascular endothelial cell protein expression.

血管功能在慢性肾脏疾病的评估

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this ...

Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research

The vascular endothelium is a monolayer of cells that cover the interior of blood vessels and provide both structural and functional roles. The endothelium acts as a barrier, preventing leukocyte adhesion and aggregation, as well as controlling permeability to plasma components. Functionally, the endothelium affects vessel tone.
Endothelial dysfunction is an imbalance between the chemical species which regulate vessel tone, thombroresistance, cellular proliferation and mitosis. It is the first step in atherosclerosis and is associated with coronary artery disease, peripheral artery disease, heart failure, hypertension, and hyperlipidemia.
The first demonstration of endothelial dysfunction involved direct infusion of acetylcholine and quantitative coronary angiography. Acetylcholine binds to muscarinic receptors on the endothelial cell surface, leading to an increase of intracellular calcium and increased nitric oxide (NO) production. In subjects with an intact endothelium, vasodilation was observed while subjects with endothelial damage experienced paradoxical vasoconstriction.
There exists a non-invasive, in vivo method for measuring endothelial function in peripheral arteries using high-resolution B-mode ultrasound. The endothelial function of peripheral arteries is closely related to coronary artery function. This technique measures the percent diameter change in the brachial artery during a period of reactive hyperemia following limb ischemia.
This technique, known as endothelium-dependent, flow-mediated vasodilation (FMD) has value in clinical research settings. However, a number of physiological and technical issues can affect the accuracy of the results and appropriate guidelines for the technique have been published. Despite the guidelines, FMD remains heavily operator dependent and presents a steep learning curve. This article presents a standardized method for measuring FMD in the brachial artery on the upper arm and offers suggestions to reduce intra-operator variability.

Endothelial dysfunction is associated with numerous disease states and is predictive of adverse cardiovascular events in humans. Flow-mediated vasodilation (FMD) is a non-invasive ultrasound method of evaluating endothelial function. Methodological choices and operator experience may affect results. A systematic approach to FMD in human studies is discussed here.

肱动脉的临床研究超声评价血管内皮依赖性血流介导的血管舒张功能

The vascular endothelium is a monolayer of cells that cover the interior of blood vessels and provide both structural and functional roles. The ...

A Methodological Approach to Non-invasive Assessments of Vascular Function and Morphology

The endothelium is the innermost lining of the vasculature and is involved in the maintenance of vascular homeostasis. Damage to the endothelium may predispose the vessel to atherosclerosis and increase the risk for cardiovascular disease. Assessments of peripheral endothelial function are good indicators of early abnormalities in the vascular wall and correlate well with assessments of coronary endothelial function. The present manuscript details the important methodological steps necessary for the assessment of microvascular endothelial function using laser Doppler imaging with iontophoresis, large vessel endothelial function using flow-mediated dilatation, and carotid atherosclerosis using carotid artery ultrasound. A discussion on the methodological considerations for each of the techniques is also presented, and recommendations are made for future research.

The present article describes the methodological considerations for several non-invasive assessments of vascular function and morphology that are commonly used in medical research to assess different stages of atherosclerosis.

方法论方法血管功能和形态的非侵入性评估

The endothelium is the innermost lining of the vasculature and is involved in the maintenance of vascular homeostasis.  Damage to the endothelium may ...

Ultrasound Assessment of Endothelial Function: A Technical Guideline of the Flow-mediated Dilation Test

Cardiovascular disease is the primary cause of mortality and a major cause of disability worldwide. The dysfunction of the vascular endothelium is a pathological condition characterized mainly by a disruption in the balance between vasodilator and vasoconstrictor substances and is proposed to play an important role in the development of atherosclerotic cardiovascular disease. Therefore, a precise evaluation of endothelial function in humans represents an important tool that could help better understand the etiology of multiple cardio-centric pathologies.
Over the past twenty-five years, many methodological approaches have been developed to provide an assessment of endothelial function in humans. Introduced in 1989, the FMD test incorporates a forearm occlusion and subsequent reactive hyperemia that promotes nitric oxide production and vasodilation of the brachial artery. The FMD test is now the most widely utilized, non-invasive, ultrasonic assessment of endothelial function in humans and has been associated with future cardiovascular events.
Although the FMD test could have clinical utility, it is a physiological assessment that has inherited several confounding factors that need to be considered. This article describes a standardized protocol for determining FMD including the recommended methodology to help minimize the physiological and technical issues and improve the precision and reproducibility of the assessment.

The flow mediated dilation (FMD) test is the most commonly utilized, non-invasive, ultrasound assessment of endothelial function in humans. Although the FMD test has been related with the prediction of future cardiovascular disease and events, it is a physiological assessment with many inherent confounding factors that need to be considered.

血管内皮功能的超声评估:血流介导的舒张试验的技术指导原则

Cardiovascular disease is the primary cause of mortality and a major cause of disability worldwide. The dysfunction of the vascular endothelium is a ...

Laser Doppler: A Tool for Measuring Pancreatic Islet Microvascular Vasomotion In Vivo

As a functional status of microcirculation, microvascular vasomotion is important for the delivery of oxygen and nutrients and the removal of carbon dioxide and waste products. The impairment of microvascular vasomotion might be a crucial step in the development of microcirculation-related diseases. In addition, the highly vascularized pancreatic islet is adapted to support endocrine function. In this respect, it seems possible to infer that the functional status of pancreatic islet microvascular vasomotion might affect pancreatic islet function. Analyzing the pathological changes of the functional status of pancreatic islet microvascular vasomotion may be a feasible strategy to determine contributions that pancreatic islet microcirculation makes to related diseases, such as diabetes mellitus, pancreatitis, etc. Therefore, this protocol describes using a laser Doppler blood flow monitor to determine the functional status of pancreatic islet microvascular vasomotion, and to establish parameters (including average blood perfusion, amplitude, frequency, and relative velocity of pancreatic islet microvascular vasomotion) for evaluation of the microcirculatory functional status. In a streptozotocin-induced diabetic mouse model, we observed an impaired functional status of pancreatic islet microvascular vasomotion. In conclusion, this approach for assessing pancreatic islet microvascular vasomotion in vivo may reveal mechanisms relating to pancreatic islet diseases.

Laser Doppler: A Tool for Measuring Pancreatic Islet Microvascular Vasomotion In Vivo

Pancreatic islet microvascular vasomotion regulates islet blood distribution and maintains the physiological function of islet &#946; cells. This protocol describes using a laser Doppler monitor to determine the functional status of pancreatic islet microvascular vasomotion in vivo and to assess the contributions of pancreatic islet microcirculation to pancreatic-related diseases.

激光多普勒: 一种测量胰岛微血管血管舒缩体内的工具

As a functional status of microcirculation, microvascular vasomotion is important for the delivery of oxygen and nutrients and the removal of carbon ...

Assessment of Human Adipose Tissue Microvascular Function Using Videomicroscopy

While obesity is closely linked to the development of metabolic and cardiovascular disease, little is known about mechanisms that govern these processes. It is hypothesized that pro-atherogenic mediators released from fat tissues particularly in association with central/visceral adiposity may promote pathogenic vascular changes locally and systemically, and the notion that cardiovascular disease may be the consequence of adipose tissue dysfunction continues to evolve. Here, we describe a unique method of videomicroscopy that involves analysis of vasodilator and vasoconstrictor responses of intact small human arterioles removed from the adipose depot of living human subjects. Videomicroscopy is used to examine functional properties of isolated microvessels in response to pharmacological or physiological stimuli using a pressured system that mimics in vivo conditions. The technique is a useful approach to gain understanding of the pathophysiology and molecular mechanisms that contribute to vascular dysfunction locally within the adipose tissue milieu. Moreover, abnormalities in the adipose tissue microvasculature have also been linked with systemic diseases. We applied this technique to examine depot-specific vascular responses in obese subjects. We assessed endothelium-dependent vasodilation to both increased flow and acetylcholine in adipose arterioles (50 - 350 &#181;m internal diameter, 2 - 3 mm in length) isolated from two different adipose depots during bariatric surgery from the same individual. We demonstrated that arterioles from visceral fat exhibit impaired endothelium-dependent vasodilation compared to vessels isolated from the subcutaneous depot. The findings suggest that the visceral microenvironment is associated with vascular endothelial dysfunction which may be relevant to clinical observation linking increased visceral adiposity to systemic disease mechanisms. The videomicroscopy technique can be used to examine vascular phenotypes from different fat depots as well as compare findings across individuals with different degrees of obesity and metabolic dysfunction. The method can also be used to examine vascular responses longitudinally in response to clinical interventions.

Videomicroscopy systems are used to examine functional properties of isolated adipose tissue arterioles in response to physiological and pharmacological stimuli. This technique can be used to examine microvascular phenotypes in different adipose tissue domains in obese humans.

应用 Videomicroscopy 评价人脂肪组织微血管功能

While obesity is closely linked to the development of metabolic and cardiovascular disease, little is known about mechanisms that govern these processes. ...

Quantitative MRI of Endothelial Permeability and (Dys)function in Atherosclerosis

Cardiovascular diseases are the leading causes of death worldwide. A permeable/leaky and dysfunctional endothelium is considered the earliest marker of vascular damage and thought to drive atherosclerosis. A method to identify these changes in vivo would be desirable in the clinic. Magnetic resonance imaging (MRI)-based tools and other technologies have enabled a profound understanding of the role of the endothelium in cardiovascular diseases and risk in vivo. There is, however, a need for reproducible and simple approaches for extracting quantifiable data reflective of endothelial damage from a single imaging study. A non-invasive, easy-to-implement, and quantitative MRI workflow was developed to acquire and analyze images that allow the quantification of two imaging biomarkers of arterial endothelial damage (leakiness/permeability and dysfunction). Here, the protocol describes the application of this method in the brachiocephalic artery of atherosclerotic ApoE-/- mice using a clinical MRI scanner. First, late gadolinium enhancement (LGE) and Modified Look-Locker Inversion Recovery (MOLLI) T1 mapping protocols to quantify endothelial leakage using an albumin-binding probe are described. Second, anatomic, and quantitative blood flow sequences to measure endothelial dysfunction, in response to acetylcholine are described. Importantly, the method outlined here allows the acquisition of high-spatial-resolution 3D images with large volumetric coverage enabling accurate segmentation of vessel wall structures to improve inter- and intra-observer variability and to increase reliability and reproducibility. Additionally, it provides quantitative data without the need for high-temporal resolution for complex kinetic modeling, making it model-independent and even allowing for imaging of highly mobile vessels (coronary arteries). Therefore, the approach simplifies and expedites data analysis. Finally, this method can be implemented on different scanners, can be extended to image different arterial beds, and is clinically applicable for use in humans. This method could be used to diagnose and treat patients with atherosclerosis by adopting a precision-medicine approach.

Quantitative MRI of Endothelial Permeability and Dysfunction in Atherosclerosis

We have developed an accurate, non-invasive, and easy-to-use method to quantify endothelial permeability and dysfunction in the arteries using Magnetic Resonance Imaging (MRI), named qMETRIC. This technique enables assessing vascular damage and cardiovascular risk associated with atherosclerosis in preclinical models and humans.

Cardiovascular diseases are the leading causes of death worldwide. A permeable/leaky and dysfunctional endothelium is considered the earliest marker of ...

生物工程

研究人类微血管功能障碍的新机制

Intradermal Microdialysis: An Approach to Investigating Novel Mechanisms of Microvascular Dysfunction in Humans

The cutaneous vasculature is an accessible tissue that can be used to assess microvascular function in humans. Intradermal microdialysis is a minimally invasive technique used to investigate mechanisms of vascular smooth muscle and endothelial function in the cutaneous circulation. This technique allows for the pharmacological dissection of the pathophysiology of microvascular endothelial dysfunction as indexed by decreased nitric oxide-mediated vasodilation, an indicator of cardiovascular disease development risk. In this technique, a microdialysis probe is placed in the dermal layer of the skin, and a local heating unit with a laser Doppler flowmetry probe is placed over the probe to measure the red blood cell flux. The local skin temperature is clamped or stimulated with direct heat application, and pharmacological agents are perfused through the probe to stimulate or inhibit intracellular signaling pathways in order to induce vasodilation or vasoconstriction or to interrogate mechanisms of interest (co-factors, antioxidants, etc.). The cutaneous vascular conductance is quantified, and mechanisms of endothelial dysfunction in disease states can be delineated.

作者聚焦:一种揭示心血管疾病风险人群机制的药物解剖方法 

Intradermal microdialysis is a minimally invasive technique used to investigate microvascular function in health and disease. Both dose-response and local heating protocols can be utilized for this technique to explore mechanisms of vasodilation and vasoconstriction in the cutaneous circulation.

皮内微透析:研究人类微血管功能障碍新机制的方法

The cutaneous vasculature is an accessible tissue that can be used to assess microvascular function in humans. Intradermal microdialysis is a minimally ...

非侵入性的评估微血管和内皮功能

摘要

探索更多视频

此视频中的章节

评估与远藤的PAT 2000内皮血管舒张功能

血管功能在慢性肾脏疾病的评估

肱动脉的临床研究超声评价血管内皮依赖性血流介导的血管舒张功能

方法论方法血管功能和形态的非侵入性评估

血管内皮功能的超声评估:血流介导的舒张试验的技术指导原则

激光多普勒: 一种测量胰岛微血管血管舒缩体内的工具

应用 Videomicroscopy 评价人脂肪组织微血管功能

Quantitative MRI of Endothelial Permeability and (Dys)function in Atherosclerosis

皮内微透析:研究人类微血管功能障碍新机制的方法

皮内微透析:研究人类微血管功能障碍新机制的方法