| Objective:To evaluate the vascular endothelial function by the high-resolution ultrasonograph and examination of the level of plasma active endothelial factors in the old patients of low-extremity atherosclerosis disease(LEASD).Also.to find out the independent predictors of endothelial function by multivariate regression analysis. At the same time,we have detected the activity of platelet, fibrinolysis and coagulative state to make sure whether the prethrombotic state exists in those patients.Methods: Both the endothelium-dependent vasoreactivity(i.e.flow-mediated dilation,FMD) and the endothelium-independent vasoreactivity(i.e. nitroglycerin-mediated dilation,NMD) of the brachial artery and the superficial femoral artery in 33 old LEASD patients have been detected by the color Doppler ultrasonograph and have been compared with 40 old healthly conrols and 30 old non-LEASD patients with cardiovascular risk factors respectively.The level of active endothelial factors such as nitric oxide(NO),endothelin(ET),thromboxane A2 (TXAa) and prostacyclin(PGl2) has been examined and compared among the above objects.Furthermore,6 factors reflecting the prethrombotic state(PTS)such as platelet a -granular membrane protein-140(GMP-140),von Willebrand factor(VWF),fibrinogen(FIB),plasminogen(PLG),d-dimer (DD) and the complex of thrombin-antithrombin ni (TAT) have also been tested and compared among those individuals.Statistical analysis was performed throughx2 test or t-testThe relation between FMD and patients' physical condition was tested by univariate or multivariate regression analysis.Results:Comparing with the old healthy controls and the non-LEASD patients with cardiovascular risk factors,there is impaired brachial FMD (3.56 ?l .92%) and NMD( 8.54 ?4.72% )in the LEASD patientsC P=0.0000). Smoking( r=-0.34,p<0.05) ,systolic blood pressure(r=-0.46,p<0.001),total cholesterol ( r=-0.39,p< 0.001 ),LDL-c( r=-0.43,p < 0.001 ),fasting glucose( r=-0.36,p < 0.05 ) and basic vascular diameter ( r=-0.47,p < 0.001 ) are associated with brachial FMD negatively.But the level of HDL-c has positive relationship with brachial FMD(r=0.27,p < 0.05). After the test of multivariate regression analysis,we have found that the basic vascular diameter (R2=0.7, p<0.001) ,systolic blood pressure(R2=0.56, p< 0.001) andtheconcentrationofLDL-c ( R2=0.4, p< 0.001) are independent predictors of brachial FMD. By the way,the most powerful predictor is the basic vascular diameter. And the superficial femoral FMD (2.16 ?1.22%) and NMD ( 5.27 ?3.69%) of the LEASD patients are impaired comparing vvith the old healthy controls and the non-LEASD patients with cardiovascular risk factors (p<0.001) ,too. As for the active endothelial factors,there is significant difFerence between the LEASD patients and other objects.The level of NO (28.88 ?8.54 ju mmol/L )and PGI2 ( 83.47 ?13.67pg/ml )is lowest ,but that of ET (95.09 ?49.18pg/ml) and TXA2 (664.4 ?331.8pg/ml) is highest in the LEASD patients comparing vvith the other two groups (p<0.01) .So,there is further evidence indicating the impaired endothelial function of LEASD patients.The difference of the factors reflecting the PTS are also found between the above three groups.The level of GMP-140 (14.06 ?2.18 u g/L) ,DD (2.92 ?1.3 ja g/ml) ,VWF (104.42 ?31.4% )and FIB( 606.8 ?117.8 mg/dl )is higher in LEASD patients than in other individuals (p<0.001) . ConcIusions:l.There is endothelial dvsfunction in the patients of LEASD,and thebasic vascular diameter,systolic blood pressure and the concentration of LDL-c are independent predictors of endothelial function. 2.There is close relationship between the impaired endothelial function and the pathogenesis of LEASD.3. The endothelium-independent vasoreactivity is impaired in the patients of LEASD.4.PTS exists in the patients of LEASD.5. The impaired endothelial function may contribute to PTS in some extent.6.We should pay more attention to the control of cardiovascular risk factors,improvement of the endothelial function and us...
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