高三酰甘油血症血流变化特点与一氧化氮活性及血管扩张效应改变的相关研究  

Correlation between characteristics of blood flow and changes of NO level in hypertriglycerlipidemic patients

作　　者：吴峻[1] 易家骥[1] 孙明[2] 周宏研[2] 区碧如[1] 陈敏生[1] 许辉[2] 

机构地区：[1]广州医学院第一附属医院心内科,广州510120 [2]中南大学湘雅医院心内科

出　　处：《临床心血管病杂志》2004年第7期403-406,共4页Journal of Clinical Cardiology

摘　　要：目的 :探讨高三酰甘油 (TG)血症时血流动力学变化特点及其对血管内皮功能的影响机制。方法 :以 2 0例正常人、6 0例高TG血症患者 (其中 30例予以饮食治疗、30例予吉非罗齐治疗 )为观察对象 ,以肱动脉B超测量血管结构、血流和内皮依赖的舒张功能改变 ,并检测血浆一氧化氮 (NO)、氧化型低密度脂蛋白 (oxLDL)、血脂、血糖的变化。结果 :与正常对照组比较 ,除了常规血脂生化指标异常升高外 ,TG血症患者还有血oxLDL浓度升高、NO活性下降 ,且NO水平与TG、总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL C)和oxLDL浓度呈负相关。血管超声中心肌内温度、收缩期内径和舒张期内径差异无统计学意义 ,而平均血流速度 (Vm)、平均剪切率 (MSR)以及血流介导的扩张效应 (FMD)均显著减小 ,与NO水平呈正相关。 8周的低脂饮食治疗可使总胆固醇TC、TG水平下降 ,但NO、oxLDL和血管超声差异无统计学意义 ;吉非罗齐治疗组血TG、TC、LDL C和oxLDL浓度下降、NO浓度增高 ,血管超声FMD、Vm、MSR显著升高 ,而结构尚未见明显改变。结论 :高TG血症时TC、TG、LDL C水平和oxLDL共同参与了内皮的损伤机制 ,血流减缓、血流剪切率下降与NO活性的下降密切相关 ,临床表现为血管舒张功能的下降 ,调脂治疗有利于内皮舒张功能的改善。Objective:To investigate the impacts of hypertriglycerlipidemia on hemodynamics and vascular endothelial function.Method:Sixty hypertriglycerlipidemic patients were randomized into two groups(30 with low-fat diet treatment, 30 with gemfibrozil) compared with 20 normal controls. Vessel structure, hemodynamic index and endothelium-dependent vasodilation were assessed by B-mode ultrasound imager located in brachial artery. Serum NO, oxLDL, TC, TG, LDL-C, HDL-C, FBG, ALT and AST were measured.Result:Compared with controls, hypertriglycerlipidemic patients had higher level of oxLDL and lower level of NO,the last was inversely correlated with TG,TC, LDL-C, oxLDL. Hypertriglycerlipidemic patients had shown no significant difference in IMT?Ds and Dd, but lower Vm, MSR and FMD in dynamics index were correlated with NO. 8 weeks of low-fat diet could reduce TC and TG, but make no difference in NO, oxLDL and ultrasonic images. On the other hand, 8 weeks of gemfibrozil treatment not only reduced TG, TC, LDL-C and oxLDL, but also elevated NO, Vm, MSR resulted in increase of FMD.Conclusion:The endothelial impairment of hypertriglycerlipidemic patients might be caused by high level of TC,TG,LDL-C as well as oxidative substance such as oxLDL which could inactivate NO. The insufficiency of NO led by lower shear rate could result in descent of endothelium-dependent relaxation. Gemfibrozil treatment could improve endothelium-dependent relaxation.

关 键 词：高三酰甘油血症 血流动力学 内皮依赖的舒张功能 

分 类 号：R392[医药卫生—免疫学]