冷加压负荷超声心动图及冠状动脉血流显像技术评价冠状动脉微循环内皮功能  

Evaluation of the Coronary Endothelial Function in Patients with Angiographically Normal Coronary Arteries by Cold Pressor Test Echocardiography and Coronary Flow Imaging

作　　者：李馨[1] 何疆春[2] 贺声[1] 张云山[1] 沈燕华[1] 

机构地区：[1]海军总医院超声诊断科,北京100048 [2]海军总医院心内科,北京100048

出　　处：《海军总医院学报》2009年第1期13-16,共4页Journal of Naval General Hospital of PLA

摘　　要：目的应用冷加压负荷超声心动图及冠状动脉血流显像技术,评价冠状动脉造影结果正常的冠心病高危人群的冠状动脉微循环内皮功能,为临床检测冠心病早期冠状动脉微循环内皮功能损伤提供一种新的影像学研究手段。方法选择健康志愿者(第1组)和冠状动脉造影结果正常的冠心病高危人群(第2组)各20例,分别于静息状态下、冷加压负荷实验后、舌下含服硝酸甘油后测量冠状动脉左主干内径并计算其内径变化百分率;测量冠状动脉左前降支舒张期峰值血流速度并计算其流速变化百分率。通过比较干预状态下两组冠状动脉左主干内径的变化率及前降支流速的变化率达到评估冠状动脉内皮功能的目的。结果①静息状态下两组冠状动脉内径及峰值流速基础值之间差异均无统计学意义(P>0.05)。②冷加压实验后,第2组冠状动脉内径扩张百分率为(4.53±2.65)%、冠状动脉流速增加百分率为(23.64±5.72)%,明显低于第1组的(11.37±3.29)%及(43.76±4.28)%,两组比较有显著性(P<0.05)。③含服硝酸甘油后,第2组冠状动脉内径扩张百分率为(15.64±2.41)%、流速增加百分率为(45.07±4.14)%与第1组的(14.75±3.18)%及(46.12±3.92)%之间差异无统计学差异(P>0.05)。结论冠心病高危人群在冠状动脉造影结果正常时可能已合并有冠状动脉微循环内皮功能损伤,冷加压负荷超声心动图及冠状动脉血流显像技术评价冠状动脉内皮功能有一定可行性。Objective To evaluate the coronary endothelial function in patients with risk factors for coronary artery disease and angiographically normal coronary arteries by cold pressor test （CPT） echocardiography and coronary flow imaging and to establish a way to detect endothelium function. Methods Fourty subjects were divided into two groups. Group 1 consisted of 20 subjects with no risk factors for coronary artery disease. Group 2 consisted of 20 subjects with risk factors for coronary artery disease and angiographically normal coronary arteries. The left main coronary（LMC） diameter and the coronary peak velocity （CPV） were recorded under resting condition,after cold pressor test and taking sublingual nitroglycerin respectively in two groups. The percent changes of LMC diameter and of CPV after CPT and nitroglycerin administration in two groups were calculated for the assessment of endothelium functions. Results After CPT,both the percent increase in LMC diameter and in CPV in patients of group 2 were lower than those in group 1 （P〈0.05）. There was no significant difference between group 1 and group 2 after nitroglycerin administration （P〉 0.05）. Conclusion Coronary endothelium dependent vasodilation is found to be intact in normal subjects compared with patients with risk factors. Echocardiography with cold pressor can be used to evaluate the coronary endothelial funcnon.

关 键 词：冠状动脉内皮功能 冷加压负荷超声心动图 冠状动脉血流显像 

分 类 号：R540.45[医药卫生—心血管疾病] R322.12[医药卫生—内科学]