Endo-PAT评估不同剂量叶酸对冠心病患者血管内皮功能的影响  

The effects of different dosage of folic acid on vascular endothelial function in patients with coronary heart disease by Endo-PAT

作　　者：林辉[1] 翟小亚[1] 蒋承建[1] 孟立平[1] 郭艳[1] 池菊芳[1] 郭航远[1] LIN Hui;ZHAI Xiaoya;JIANG Chengjian(Department of Cardiology, Shaoxing People’s Hospital(Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing 312000, China)

机构地区：[1]浙江省绍兴市人民医院(浙江大学绍兴医院)心内科

出　　处：《心电与循环》2019年第4期292-296,共5页Journal of Electrocardiology and Circulation

基　　金：绍兴市科技计划项目(2015B70046)

摘　　要：目的探讨无创血管内皮功能检测系统Endo-PAT评估不同剂量叶酸对冠心病患者内皮功能的影响。方法选择冠心病患者104例,分为叶酸低剂量组(n=36)、叶酸高剂量组(n=33)和对照组(n=35)。对照组给予冠心病常规治疗,叶酸低剂量组和叶酸高剂量组在上述基础上分别给予5mg和15mg叶酸治疗,随访6个月,测定血脂水平、Hcy水平和血浆内皮标志物、反应性充血指数(RHI)及颈动脉内膜中层厚度(IMT)。Peasrson相关分析RHI与IMT的相关性。结果 6个月治疗后3组低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)和甘油三酯(TG)、血浆Hcy水平、内皮素1(ET-1)和人可溶性细胞间黏附分子1(s ICAM-1)下降,而高密度脂蛋白胆固醇(HDL-C)和一氧化氮(NO)升高(均P<0.05)。叶酸高剂量组与叶酸低剂量组LDL-C、TC和TG、ET-1、NO和s ICAM-1水平比较差异均无统计学意义(均P>0.05);与对照组和叶酸低剂量组比较,叶酸高剂量组HDL-C水平增加(均P<0.05)。Hcy水平叶酸高剂量组低于叶酸低剂量组。治疗后,3组RHI和IMT均下降,叶酸低剂量和高剂量组下降幅度大于对照组(均P<0.05);但叶酸高剂量组与叶酸低剂量组RHI和IMT比较差异无统计学意义(均P>0.05)。相关性分析表明叶酸低剂量组和高剂量组RHI增加量和IMT减少量均存在负相关(r=-0.6034、-0.7381,均P<0.01)。结论小剂量叶酸适合临床冠心病患者的治疗。Objective To investigate the effects of different dosage of folic acid on endothelial function in patients with coronary heart disease. Methods 104 patients with coronary heart disease admitted to our hospital from January2016 to January 2018 were enrolled. Patients were randomly assigned to the control group(n=35), low-dose folic acid group( LF, n=36) and high-dose folic acid group(HF, n=33). The control group received conventional treatment for coronary heart disease. LF group and HF group were given 5 mg and 15 mg of folic acid, respectively, in addition to basic conventional treatment. The levels of blood lipid, homocysteine(Hcy) and endothelium markers, and the reactive hyperemia index(RHI) and carotid intima-media thickness(IMT) were measured before and after treatment of 6 months.Peasrson correlation analysis was used to evaluate the relationship between RHI and IMT. Results The levels of low-density lipoprotein(LDL-C), total cholesterol(TC), triglyceride(TG), plasma Hcy, endothelin-1(ET-1) and soluble intercellular adhesion molecule-1(s ICAM-1) decreased, while high-density lipoprotein(HDL-C) and nitric oxide(NO)increased in all 3 groups after 6 months’ treatment(P <0.05 for all). LDL-C, TC, TG, ET-1, NO and s ICAM-1 were not significant difference between LF and HF groups. Compared with control group and LF group, HDL-C level increased in HF group(P <0.05). Hcy was lower in HF group than LF group. After treatment, RHI and IMT decreased in all 3 groups,and the decrease of RHI and IMT in LF and HF groups was significantly greater than in control group(P<0.05). There was no significant difference of RHI and IMT between LF group and HF group. Analysis showed there was a negative correlation between the increase of RHI and the decrease of IMT in both LF and HF groups(r=-0.6034、-0.7381, all P <0.01). Conclusion Low-dose folic acid is suitable for the treatment of patients with coronary heart disease.

关 键 词：冠心病 内皮功能 Endo-PAT 叶酸 同型半胱氨酸 

分 类 号：R541.4[医药卫生—心血管疾病]