冠状动脉痉挛患者血脂与血管内皮功能的相关性研究  

Relationship Between Dyslipidemia and Vascular Endothelial Function in Patients With Coronary Artery Spasm

作　　者：向定成[1] 张金霞[1] 阮云军[1] 何喜民[1] 龚志华[1] 何建新[1] 洪长江[1] 邱健[1] 马骏[1] 

机构地区：[1]中国人民解放军广州军区广州总医院心内科,广东省广州市510010

出　　处：《中国循环杂志》2006年第4期270-272,共3页Chinese Circulation Journal

基　　金：广东省自然科学基金(032186)

摘　　要：目的:探讨冠状动脉痉挛患者的血脂水平与血管内皮细胞功能的关系。方法:选择因静息性胸痛住院、且冠状动脉造影无显著狭窄的患者64例,经乙酰胆碱激发试验分为冠状动脉痉挛组(痉挛组,n=46例)和非痉挛组(对照组,n=18例),分别测定并比较两组的血脂谱及血清内皮素(ET-1)、一氧化氮(NO)和血脂水平,痉挛组接受至少6个月的钙拮抗剂、调脂治疗和抗血小板联合治疗,复查ET-1、No及血脂。结果:痉挛组患者的血清ET-1及低密度脂蛋白胆固醇(LDL-C)水平均显著高于对照组(P<0．05),而No和高密度脂蛋白胆固醇(HDL-C)水平均低于对照组但无显著统计学意义(P>0．05)。经过联合治疗6个月后,ET-1、LDL-C及TG水平均显著降低,NO及HDL-C均显著升高(P<0．05);胸痛发作频次由(6±3)次／月减少到(1±2)次／月(P<0．001)。痉挛组ET-1水平与LDL-C呈显著正相关(r=0．71,P<0．01),而与HDL-C呈负相关(r=-0．48,P<0．05)。NO水平与LDL-C呈显著负相关(r=-0．65,P<0．01),而与HDL-C呈显著正相关(r=0．69,P<0．01)。结论:ET-1升高和NO储备降低是冠状动脉痉挛的重要病理生理基础之一,LDL-C和HDL-C是血管内皮功能紊乱的重要相关因素,联合治疗在改善血脂代谢的同时能逆转内皮细胞功能,并缓解临床症状。Objectives ： This study was aimed to investigate the effects of dyslipidemia on vascular endothelial function in patients with coronary artery spasm. Methods： Sixty-four patients with chest pain but without significant angiographic stenosis were divided into coronary spasm group （n =46 with coronary spasm） and control group （n = 18 without coronary spasm） according to acetylcholine provoking test. Endothelin-1 （ET-1）, nitric oxide （NO） and lipids were measured in two groups and repeated in spasm group after treated with calcium channel blockers, by lipids-lowering and antiplatelet therapies at least for six months. Results： ET-1 and LDL-C were significantly elevated（P 〈0. 05）, and NO and HDL-C were slightly lowered （P 〉0. 05） in spasm group compared with control group. Six months after combined treatment, ET-1, LDL-C and TG were decreased and NO and HDL-C were increased significantly in spasm group （P 〈0. 05）. The frequency of chest pain was reduced from 6 ±3 to 1 ±2 times per month （P 〈0. 001 ）. ET-1 was positive related to LDL-C（r =0. 71 ,P 〈0. 01 ） but negative related to HDL-C （r = -0. 48 ,P 〈 0. 05）. However, NO was negative related to LDL-C（r = -0. 65, P 〈0. 01 ） and positive related to LDL-C （r =0. 69 ,P 〈0. 01 ）. Conclusion： Elevated ET-1 and decreased reservation of NO might be one of pivotal roles in pathogenesis of coronary spasm. Vascular endothelial dysfunction was significantly related to the levels of elevated LDL-C and decreased HDL-C, which may be reversed by combined treatment.

关 键 词：冠状动脉痉挛 乙酰胆碱试验血脂 内皮素 一氧化氮 

分 类 号：R541[医药卫生—心血管疾病]