增强型体外反搏治疗对冠心病支架术后患者心肌微循环功能的影响  

Effect of enhanced external counterpulsation on microvascular dysfunction in patients with coronary artery disease after coronary stent implantation

作　　者：梁建文 李小玲[1] 吴奋生 张焕基[1] 伍贵富[1] LIANG Jian-wen;LI Xiao-ling;WU Fen-sheng;ZHANG Huan-ji;WU Gui-fu(The Eighth Affiliated Hospital of Sun Yat-sen University,Shenzhen,Guangdong 518033,China)

机构地区：[1]中山大学附属第八医院心血管内科,广东深圳518033

出　　处：《岭南心血管病杂志》2018年第3期253-257,271,共6页South China Journal of Cardiovascular Diseases

基　　金：广东省省级科技计划项目(项目编号:2017A020 215130);深圳市福田区卫生公益性科研项目(项目编号:FTWS2015013)

摘　　要：目的研究增强型体外反搏(enhanced external counterpulsation,EECP)治疗对冠状动脉粥样硬化性心脏病(冠心病)支架术后患者心肌微循环阻力的影响。方法选择中山大学附属第八医院2015年3月至2016年12月期间已行支架植入的冠心病患者40例,经压力导丝测定微循环阻力指数(index of microcirculatoryresistance,IMR)后分为EECP组(n=23)和对照组(n=17),两组均给予规范的冠心病二级预防治疗,EECP组术后给予35次EECP治疗(5天/周,60 min/次),随访6个月时复查冠状动脉造影和复测靶血管IMR。结果入组时两组的IMR均高于正常上限[EECP组:(32.83±4.83)U,对照组:(34.12±4.77)U];两组随访6个月时C反应蛋白(CRP)(P<0.05)、低密度脂蛋白胆固醇(LDL-C)浓度(P<0.05)较入组时均显著下降,血流介导的内皮舒张功能(flow mediated dilation,FMD)较入组时升高(EECP组:8.40%±1.32%vs.7.28%±1.50%,P<0.05;对照组:7.88%±1.55%vs.7.56%±1.72%,P<0.05);随访6个月时EECP组IMR较入组时明显下降[(29.10±3.55)U vs.(32.83±4.83)U,P<0.001],而对照组无明显降低[(32.21±3.72)U vs.(34.12±4.77)U,P=0.054]。对可能影响IMR的指标行多因素回归分析发现,FMD有独立预测价值(β=4.23,OR=28.32,P<0.05)。结论 EECP降低了冠心病支架术后患者的心肌微循环阻力,IMR的下降可能与FMD改善相关。Objectives To investigate the effect of enhanced external counterpulsation（EECP） on myocardiummicrovascular dysfunction in patients with coronary artery disease after drug-eluting stent implantation. Methods Totally 40 patients with coronary artery disease after stent implantation in The Eighth Affiliated Hospital of Sun Yat-senUniversity from March 2015 to February 2016 were selected. After detecting the index of microcirculatory resistance（IMR）,the patients were divided into EECP group（n=23） and control group（n=17）. EECP group was given astandard EECP procedure for 35 times（60 minutes per day,5 days per week and lasted for 7 weeks）,while onlystandard medical treatment according to guidelines was allocated to control group. Coronary artery angiography and IMRwere reexamined after 6-month follow-up. Results IMR exceeded the normal limit in all subjects[EECP group：（32.83 ± 4.83）U,control group：（34.12 ± 4.77）U]. Serum concentrations of C-reactive protein and low-densitylipoprotein cholesterol decreased while flow mediated dilation（FMD）（EECP group：8.40%±1.32% vs. 7.28%±1.50%,P0.05;control group：7.88%±1.55% vs. 7.56%±1.72%,P0.05）increased in both groups. After 6-month follow-up,IMR declined significantly in EECP group[（29.10±3.55）U vs.（32.83±4.83）U,P0.001],however,no similarpattern was found in control group[（32.21 ± 3.72）U vs.（34.12 ± 4.77）U,P=0.054]. After multivariate regressionanalysis,FMD was found still independently correlated with IMR（β=4.23,OR=28.32,P0.05）. Conclusions EECPimproves myocardium microcirculatory dysfunction in patients with coronary artery disease after stent implantation,andFMD might be an independent predictor for IMR change.

关 键 词：冠状动脉疾病 增强型体外反搏 微循环障碍 阻力指数 血流介导的内皮舒张功能 

分 类 号：R541.4[医药卫生—心血管疾病]