INTEGRAL STIFFNESS OF THE ARTERIAL SYSTEM AND ENDOTHELIAL FUNCTION IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Objective: to study the integral stiffness of the arterial system in patients with systemic lupus erythematosus (SLE) and its relationship to vasoactive regulatory endothelial function.

Subjects and methods. The investigation included 51 patients with SLE, including 45 (88%) women and 6 (12%) men at the age of 17 to 52 years (mean age 34±8.3 years). A control group consisted of 31 healthy volunteers aged 22 to 47 years (mean age 31±5.65 years). Among them, there were 23 (74%) women and 8 (26%) men. The ultrasound method described by D. Celermajer et al. and modified by the authors of this article was used to evaluate endothelial function. The cardiovascular system model developed by A.E. Teregulov was employed to calculate volumetric elasticity coefficient (VEC), mean blood pressure (BP), total peripheral vascular resistance (TPVR), and VEC/TPVR ratio.

 Results and discussion. In the patients with SLE, the stiffness of the arterial system was significantly higher than that in the control subjects (p < 0.001). According to the results of a reactive hyperemia test, the patients with SLE were divided into two subgroups: 1) 20 (39%) patients with a normal response of the brachial artery; 2) 31 (61%) patients with endothelial dysfunction. The values of arterial system stiffness and TPVR were independent of endothelial function,  SLE activity, and kidney involvement. Patients with disease duration more than 5 years had higher VEC (p = 0.049) and VEC/TPVR ratio (p = 0.044) than those with a shorter history of SLE. The stiffness of the arterial system was higher in hypertensive patients (p = 0.049) whereas VEC/TPVR ratios were unrelated to BP values. Thus, as compared with the control subjects, the patients with SLE had significantly higher integral arterial system stiffness that in these patients depended on arterial lesion, disease duration and BP. In SLE patients, endothelial dysfunction did not affect the formation of arterial system stiffness either.

1. Насонова ВА, Насонов ЕЛ. Рациональная фармакотерапия ревматических заболеваний: Руководство для практикующих врачей. Москва: Литтерра; 2003. [Nasonova VA, Nasonov EL. Ratsional'naya farmakoterapiya revmaticheskikh zabolevanii: Rukovodstvo dlya praktikuyushchikh vrachei [Rational pharmacotherapy of rheumatic diseases: A guide for practitioners]. Moscow: Litterra; 2003].

2. Keberle М, Тооу НР, Jahns R, et al. Assessment of microvascular changes in Raynaud's рhеnоmеnоn and connective tissue disease using colour Doppler ultrasound. Rheumatology. 2000;39:1206–13. doi: 10.1093/rheumatology/39.11.1206

3. Harper L, Savage C. Pathogenesis of ANCA-associated systemic vasculitis. J Pathol. 2000;190(3):349–59. doi: 10.1002/(SICI)1096-9896(200002)190:3<349::AIDPATH524>3.0.CO;2-A

4. Clаnсу R. Circulating endothelial cells and vascular injury in systemic lupus erythematosus. Curr Rheumatol Rep. 2000 Feb;2(1):39–43.

5. Singh R, Mengi S. Pathogenesis of atherosclerosis: A multifactorial process. Exp Clin Cardiol. 2002;7(1):40–53.

6. Орлова ЯА, Агеев ФТ. Жесткость артерий как интегральный показатель сердечно-сосудистого риска: физиология, методы оценки и медикаментозной коррекции. Сердце. 2006;5(2):65–9. [Orlova YaA, Ageev FT. Arterial stiffness as an integral indicator of cardiovascular risk: physiology, methods of assessment and medical correction. Serdtse. 2006;5(2):65–9. (In Russ.)].

7. Stokes GS, Barin ES, Gilfillian K. Effects of isosorbide mononitrate and all inhibition on pulse wave reflection in hypertension. Hypertension. 2003;41:297–301. doi: 10.1161/01.HYP.0000049622.07021.4F

8. Шилкина Н, Савина Ж, Юнонин И, Масина И. Влияние аутоиммунного воспаления на развитие атеросклероза у больных системной красной волчанкой. Врач. 2012;(10):56–9. [Shilkina N, Savina Zh, Yunonin I, Masina I. Influence of autoimmune inflammation in the development of atherosclerosis in patients with systemic lupus erythematosus. Vrach. 2012;(10):56–9. (In Russ.)].

9. Никитин ЮП, Лапицкая ИВ. Артериальная жесткость: показатели, методы определения и методологические трудности. Кардиология. 2005;(11):113–20. [Nikitin YuP, Lapitskaya IV. Arterial stiffness: indicators and methods for determining the methodological difficulties. Kardiologiya. 2005;(11):113–20. (In Russ.)].

10. Терегулов ЮЭ, Терегулов АЭ. Жесткость артериальной системы как фактор риска сердечно-сосудистых осложнений: методы оценки. Практическая медицина. 2011;52(4):133–7. [Teregulov YuE, Teregulov AE. Stiffness of the arterial system as a risk factor for cardiovascular disease: evaluation methods. Prakticheskaya meditsina. 2011;52(4):133–7. (In Russ.)].

11. Tan EM, Cohen AS, Fries JF. The 1982 revised criteria for the classification of systemic lupus erythematosus. Artithis Rheum. 982;25(11):1271–7. doi: 10.1002/art.1780251101

12. Celermajer DS, Sorensen KE, Cooch VM. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992;340:1111–5. doi: 10.1016/0140-6736(92)93147-F

13. Терегулов ЮЭ, Хусаинова ДК, Салихов ИГ и др. К методологии проведения пробы и оценки эндотелийзависимой дилатации плечевой артерии. Эхография. 004;5(3):217–21. [Teregulov YuE, Khusainova DK, Salikhov IG, et al. By the methodology of the sample and evaluate endothelium-dependent dilation of the brachial artery. Ekhografiya. 2004;5(3):217–21. (In Russ.)].

14. Терегулов АЭ. Способ определения объемной упругости артериальной системы. Патент № Ru 2373843. [Teregulov AE. Sposob opredeleniya ob’emnoi uprugosti arterial'noi sistemy. [A method for determining the volume elasticity of the arterial system]. Patent № Ru 2373843.

15. Зеленева НВ. Ультразвуковая диагностика нарушений функции эндотелия и особенности изменений сосудистого русла у больных ревматоидным артритом и системной красной волчанкой. Литературный обзор. Вестник Российского научного центра рентгенорадиологии Минздрава России. 2010;10(1). [Zeleneva NV. Sonographic diagnostics of endothelial function impairment and features of vascular changes in patients with rheumatoid arthritis and systemic lupus erythematosus. Vestnik Rossiiskogo nauchnogo tsentra rentgenoradiologii Minzdrava Rossii. 2010;10(1). (In Russ.)].

16. Cypiene A, Kovaite M. Arterial wall dysfunction in systemic lupus erythematosus. Lupus. 2009;18:522–9. doi: 10.1177/0961203308099625

17. Yildiz M. Arterial distensibility in chronic inflammatory rheumatic disorders. Cardiovasc Med J. 2010;4:83–8. doi: 10.2174/1874192401004020083

18. Савицкий НН. Биофизические основы кровообращения и клинические методы изучения гемодинамики. Москва: Медицина; 1974. 307 с. [Savitskii NN. Biofizicheskie osnovy krovoobrashcheniya i klinicheskie metody izucheniya gemodinamiki [Biophysical bases circulation and clinical methods for studying hemodynamic]. Moscow: Meditsina; 1974. 307 p.].