高胆固醇血症患者铁贮水平与心肌灌注、左心室功能及血管造影形态学特征的相关研究  

Impact of body iron status on myocardial perfusion,left ventricular function,and angiographic morphology in patients with hypercholesterolemia

作　　者：孙秀玲[1] 马建国[2] 

机构地区：[1]临沂医学专科学校生化教研室,山东临沂276002 [2]临沂市人民医院心内科,山东临沂27600

出　　处：《中国心血管杂志》2004年第4期249-253,共5页Chinese Journal of Cardiovascular Medicine

摘　　要：目的　评价血清铁参数与高胆固醇血症 (Hypercholesterolemia,HCL)患者心肌灌注、室壁运动异常及血管造影的冠状动脉疾病 (Coron aryartery disease,CAD)程度的相互关系。方法　选择 38例具有高胆固醇血症 [低密度脂蛋白 (L DL - C) >3.38m mol/ L ]从未治疗过的男性患者 ,平均年龄 (5 9± 6 )岁 ,作为 HCL组和 32例年龄匹配而胆固醇水平正常 (Normo cholester lemia,NCL )的男性为 NCL组 ,进行冠状动脉造影并在 10 d内行 99m Tc-甲氧基异丙基异氰 (MIBI) SPECT检查。结果　在 HCL组发现血清铁蛋白与心肌灌注系数 (γ=0 .70 ,P<0 .0 0 1) ,可逆系数 (γ=0 .6 6 ,P<0 .0 1)和心室壁运动系数 (γ=0 .5 3,P<0 .0 5 )之间呈显著性相关 :而总铁结合力与灌注系数之间呈一弱(负 )相关 (r=- 0 .5 2 ,P<0 .0 5 )。在 NCL 组铁参数与灌注系数及心室壁运动系数之间无显著性相关。多元回归分析证实血清铁蛋白水平是决定 HCL 患者 ,心肌灌注的独立因素 (β=0 .5 5 ,P>0 .0 5 )。铁参数与两组通过冠状动脉造影 (CAG)进行评分所定义的 CAD程度无关。结论　体内铁贮水平升高 ,与 HCL 患者心肌灌注和功能异常的严重性和程度有着密切的关系 ,但与 CAD的造影病变范围无关。血清铁蛋白水平增高 ,可增加铁介导的氧化应力和LObjective To assess the relationship of serum iron parameters to myocardial perfusion and wall motion abnormalities and to the extent of angiographic coronary artery disease(CAD)in patients with hypercholesterolemia(HCL).Methods Thirty-eight male patients(mean age 59±6 years)with hypercholesterolemia(LDL choleesterol> 3.38mmol/L)who had never been treated and 32 normocholesterolemic male subjects of similar age underwent coronary angiography and exercise technetium-99m sestamibigated single-photon emission computed tomography imaging within 10 days.ResultsSerum ferritin had a significant correlation with the perfusion index(γ= 0.70,P< 0.001),the reversibility index(γ=0.66,P<0.01),and the wall motion index(γ=0.53,P<0.05),whereas a relatively weak correlation was observed between total ironbinding capacity and perfusion index(inversely)(γ=- 0.52,P<0.05)in patients with HCL.Iron parameters were not associated with either perfusion or wall motion indices in the normocholesterolemic group.Stepwise multiple regression analysis confirmed these results.Ferritin was a strong determinant of perfusion in patients with HCL only(β=0.55,P>0.05).Iron parameters were not related to the angiographic extent of CAD as defined by angiographic vessel or extent score in either group.ConclusionData suggest that increased iron stores are closely associated with a greater extent and serverity of perfusion and functional abnormalities but not with the angiographic extent of CAD in pationts with HCL.Enhanced iron-mediated oxidative stress and LDL peroxidation may contribute to the hypercholesterolemia-related endothelial dysfuction and cause futher impairment of perfusion and wall motion.

关 键 词：血清铁蛋白 高胆固醇血症 心肌灌注 室壁运动 

分 类 号：R589.2[医药卫生—内分泌]