冠状动脉成形术对冠心病合并高血压患者血浆肾上腺髓质素和内皮素的影响  

A change of adrenomedulium and endothlin-1 in patients with hypertension and coronary artery lesion

作　　者：孙宁玲[1] 王伟民[1] 李明[1] 赵红[1] 陈步星[1] 王鸿懿[1] 刘喜荣[1] 翟莹[1] 

机构地区：[1]北京大学人民医院心内科,100044

出　　处：《中华心血管病杂志》2001年第4期210-212,共3页Chinese Journal of Cardiology

摘　　要：目的　探讨冠心病合并高血压病患者介入性治疗前、后肾上腺髓质素 (ADM)及内皮素 1(ET 1)的变化及意义。方法　对 2 5例冠心病合并高血压病患者 (A组 )及 2 1例冠心病无高血压病患者 (B组 )进行经皮冠状动脉腔内成形术 (PTCA)及支架置入术治疗 ,15例冠心病合并高血压未进行介入治疗的患者 (C组 )作为对照。 61例患者介入及检查治疗前、后 (即刻及 2 4h后 )静脉取血 ,采用放射免疫法测定血浆中ADM及ET 1的浓度。结果　 ( 1)三组患者介入治疗前、后 ,血压、心率无变化 ;( 2 )三支病变与单支及双支病变的患者比较心功能明显减弱 ,左室射血分数 (LVEF)A组分别为 4 3 .9%比62 .0 % ,B组分别为 5 0 %比 5 7.5 % ,C组分别为 4 4 .6%比 60 .8%。 ( 3 )A组患者介入治疗中及治疗后 ,ET 1及ADM浓度明显升高 ,并延续至 2 4h后 ,三支病变者更明显 ,与B组及C组比较P <0 .0 5。结论　冠心病合并高血压病患者介入治疗后 ,易激活血管活性肽的释放 ,有效的控制血压及纠正血管内皮的紊乱是介入治疗前后的重要干预步骤。Objective To find the change of adrenomedulium(ADM) and endothelin-1(ET-1) levels after interventional treatment in patients with hypertension and coronary artery lesion, and discuss its meaning. Methods 25 patients with coronary heart disease and hypertension (group A), and 21 patients with coronary heart disease without hypertension(group B), received PTCA and stent implantation. Fifteen patients with coronary heart disease and hypertension without interventional treatment (group C) were used as conterels. Venous blood was sampled before and after interventional treatment (including instantly and 24 hours after operation) in total of 61 patients.The plasma concentrations of ADM and ET-1 were measured by RIA. Results 1.The blood pressure and heart rate didn′t change after operation in the three groups. The cardiac function of the patients with triple vessel disease was significantly lower than the others. The LVEF in group A was 43.9%/62.0%, 50%/57.5% in group B and 44.6%/60.8% in group C before and after operation respectively. 2.The plasma concentrations of endothelin-1 and ADM increased and lasted for 24 hours in patients of group A after receiving interventional treatment. The increase was more significant in those with triple vessel disease. (compared with group B and C, P<0.05). Conclusion In patients with hypertension and coronary artery lesion, the interventional treatment may stimulate the release of vasoactive peptide. Therefore, effectively controlling the blood pressure and correcting the dysfunction of the endothelium are the important therapeutic steps before and after the interventional treatment.

关 键 词：冠心病 高血压 冠状动脉成形术 肾上腺髓质素 内皮素 

分 类 号：R540.5[医药卫生—心血管疾病]