冠状动脉轻度狭窄患者多种无创性检测指标的变化及意义  

Association between multi-noninvasive indexes and mild coronary stenosis

作　　者：杜丽根[1] 邱健[1] 阮云军[1] 董凤英[1] 洪长江[1] 马骏[1] 徐琳[1] 

机构地区：[1]广州军区广州总医院心血管内科,510010

出　　处：《中华心血管病杂志》2010年第1期31-34,共4页Chinese Journal of Cardiology

基　　金：本课题获广东省科技计划项目基金资助（2007B060401046）

摘　　要：目的通过对人选的拟行冠状动脉造影患者行内皮功能、动脉弹性、颈动脉内中膜厚度（IMT）及炎症等方面多种无创指标的检测，评价这些指标在冠状动脉粥样硬化病变特别是冠状动脉轻度狭窄患者中的变化及临床意义。方法对入选的105例患者，根据冠状动脉造影结果分为冠心病组、轻度狭窄（冠状动脉狭窄〈50％）组和对照组，检测肱-踝脉搏波传导速度（baPWV）、踝臂指数（ABI）和颈动脉IMT，并抽血检测内皮功能及炎症指标：一氧化氮（NO）、血管性假血友病因子（vWF）、超敏C反应蛋白（hs—CRP）等。结果与对照组比较，轻度狭窄组baPWV[（1482±155）cm／s比（1249±158）cm／s]、颈动脉IMT[（0．88±0．18）mm比（0．72±0．20）mm]较高，NO[（64±17）μmol／L比（83±17）μmol／L]水平较低，差异均有统计学意义（均P〈0．05）；但vWF、ABI、hs-CRP的差异无统计学意义。logistic回归分析表明baPWV（OR=1．052，95％CI：1．006—1．101）、NO（OR=0．989，95％CI：0．983～1．101）、吸烟（OR=3．850，95％CI：1．022—14．460）是影响冠状动脉轻度狭窄的因素（均P〈0．05）。结论内皮功能受损、动脉弹性、动脉IMT的改变及炎症参与了冠状动脉粥样硬化的发生与发展，其中内皮功能和动脉弹性功能的改变在一定程度上可能更能预测冠状动脉的轻度狭窄。Objective To observe the changes of multi-noninvasive indexes including endothelial function, arterial flexibility, carotid intima-media thickness （IMT） and serum inflammatory cytokines in patients with mild coronary stenosis. Methods One hundred and five patients were divided into three groups according to the result of coronary angiography ： coronary heart disease （ stenosis ≥ 50% in at least one coronary segment）, mild coronary stenosis （stenosis 〈 50% in at least one coronary segment） and control group （normal coronary）. Brachial-ankle pulse wave velocity （baPWV） and ankle-brachial index （ABI）, reflecting arterial flexibility and the lower extremity vascular disease respectively, were measured by a Colin system, carotid artery IMT was detected echocardiographically. Serum levels of NO, vWF, hs-CRP were measured before coronary angiography in all patients. Results baPWV [ （ 1482 ± 155 ） cm/s vs. （ 1249 ± 158）cm/s] and carotid IMT [ （0. 88 ±0. 18）mm vs. （0. 72 ±0. 20） mm] were significantly higher while serum levels of NO [ （64 ± 17） μmol/L vs. （83 ± 17） μmol/L] was significantly lower in mild coronary stenosis group than those in control group （ all P 〈 0. 05）. vWF, ABI and hs-CRP were similar between the two groups （ all P 〉 0. 05）. Logistic regression analysis showed that NO, baPWV, smoking are independent predicting factors for mild coronary stenosis （all P 〈 0.05 ）. Conclusions Endothelial dysfunction, reduction of the arterial flexibility as well as increased serum inflammation were associated with mild coronary stenosis.

关 键 词：冠状动脉粥样硬化 动脉弹性 炎症 

分 类 号：R541.4[医药卫生—心血管疾病] R587.1[医药卫生—内科学]