吉非罗齐对高脂血症患者氧化型低密度脂蛋白浓度及血管内皮功能的影响  

The Effect of Gemfibrozil on OxLDL and Endothelium-dependent Relaxation Function in Hypertriglycerlipidemic Patients

作　　者：吴峻[1] 何兆初[1] 孙明[2] 陈敏生[1] 区碧如[1] 许辉[2] 

机构地区：[1]广州医学院第一附属医院心内科,广东广州510120 [2]中南大学湘雅医院心内科,湖南长沙410008

出　　处：《广州医学院学报》2004年第2期17-20,共4页Academic Journal of Guangzhou Medical College

基　　金：广州医学院博士基金(编号:03-Q-05)

摘　　要：目的:探讨高甘油三酯血症对血管舒张功能的损害机制及观察短期吉非罗齐治疗对内皮功能障碍的影响。方法:以20例正常人、60例高甘油三酯血症病人(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、弹性指标和内皮依赖的舒张功能,并检测血浆一氧化氮(NO)、氧化型低密度脂蛋白(OxLDL)、血脂的变化。结果:与正常对照组比较:高甘油三酯血症病人血OxLDL浓度升高、NO活性下降,且NO水平与甘油三酯(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。血管超声中弹性指标Da、Dr显著减小,平均血管壁紧张度(MCWT)显著增大,而血流介导的扩张效应(FMD)则显著减小,并与NO水平呈正相关。8周的低脂饮食治疗可使TC、TG水平下降,但NO、OxLDL和血管超声未见显著变化;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显著升高。结论:高甘油三酯血症时TC、TG、LDL-C水平和氧化因子OxLDL共同参与了内皮的损伤机制,导致NO活性的下降,临床表现为血管舒张功能的下降和弹性下降,吉非罗齐治疗有利于内皮舒张功能的改善。Objective: To investigate the impacts of hypertriglycerlipidemia on vascular endothelial function and observe the role of gemfibrozil on ECD. Methods: 60 patients with hypertriglycerlipidemia were randomized into two groups(30 with low-fat diet treatment, 30 with gemfibrozil) compared with 20 normal contrnls. Vessel structure, hemodynamic index and endothelium-dependent vasodilatinn of brachial artery were assessed by B-mode ultrasnund scan. Serum NO, OxLDL, TC, TG, LDL-C and HDL-C were measured. Results: Compared with controls, hypertriglycerlipidemia had higher level of OxLDL and lower level of NO which inversely correlated with TG, TC, LDL-C, OxLDL. Hypertriglycerlipidemic patients shown no significant difference in IMT, Ds and Dd, but higher MCWT and lower Da, Dr, FMD which positively correlated with NO. Eigut weeks of low-fat diet could reduce TC and TG, but make no difference in NO, OxLDL and ultrasonic images. On the other hand, 8week gemfibrozil treatment not only reduced TG, TC, LDL-C and OxLDL, but also elevated NO and FMD. Conclusions: 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 and resulted in less endothelium-dependent relaxation. Gemfibrozil treatment could improve endothelium-dependent relaxation.

关 键 词：吉非罗齐 高甘油三酯血症 内皮依赖的舒张功能 

分 类 号：R543[医药卫生—心血管疾病]