高血胆固醇症病人体内铁贮水平与心肌灌注左心室功能的相关研究  

RESEARCH ON THE CORRELATION OF THE LEVEL OF IRON AND MYOCARDIAL PERFUSION AND LEFT VENTRICULAR FUNCTION OF PATIENTS WITH HYPERCHOLESTEROLEMIA

作　　者：孙秀玲[1] 马建国[2] 吴洁[3] 

机构地区：[1]临沂医专,山东临沂276002 [2]临沂市人民医院 [3]国家质检总局医务处

出　　处：《临沂医学专科学校学报》2004年第1期31-34,共4页Journal of Linyi Medical College

基　　金：临沂市科技发展计划项目 (No .0 3 3 0 15 9)

摘　　要：目的　 评价血清铁参数与高血胆固醇症 (HCL)病人心肌灌注、室壁运动异常及血管造影显示的冠状动脉疾病 (CAD)程度的相互关系。方法　 选择 38名具有高血胆固醇症 (LDL C >3.38mmol/L)从未治疗过的男性病人 (平均年龄 5 9± 6岁 )作为HCL组和 32名年龄匹配而胆固醇水平正常 (NCL)的男性为NCL组 ,进行冠状动脉造影并在 10d内行SPECT检查 ,应用99mTc 甲氧基异丙基异氰 (MIBI)进行静息 /负荷门控断层心肌灌注显像、室壁运动功能图像分析 ;同时测定血清铁参数、血脂及常规血液学参数。结果　 在HCL组发现血清铁蛋白 (SF)与心肌灌注系数 (r =0 .70 ,P <0 .0 1) ,可逆系数 (r =0 .6 6 ,P <0 .0 1)和室壁运动系数 (r =0 .5 3,P <0 .0 5 )之间呈显著性相关 ;而总铁结合力与灌注系数之间呈一弱 (负 )相关 (r = 0 .5 2 ,P <0 .0 5 )。在NCL组铁参数与灌注系数及室壁运动系数之间无显著性相关。多元回归分析证实血清铁蛋白水平是决定HCL病人中心肌灌注的独立因素 (β =0 .5 5 ,P >0 .0 5 )。铁参数与两组通过冠状动脉造影 (CAG)进行评分所定义的CAD程度无关。结论　 体内铁贮水平升高与HCL病人心肌灌注和功能异常的严重性和程度有着密切的关系 ,但与CAD的造影显示的病变范围无关。血清铁蛋白水平增高 。Objective To asess the correlation of iron level and myocardial perfusion,wall motion abnormalities and the degrees of coronary artery disease (CAD) in patients with hypercholesterolemia(HCL).Methods Thirty-eight male patients over (59±6) years old with HCL never treated before and 32 normocholesterolemic males of similar age underwent coronary angiography and single-photon emission computed tomography through technetium 99m Tc-MIBI within 10 days.The detection results of myocardial perfusion,wall motion functions and the indexes of serum ferritin,blood lipid and the routine hematology were analyzed.Results There existed a significant correlation between serum ferritin and the index of perfusion (r=0.53,P<0.01),the reversibility index(r=0.66,P<0.01) and the wall motion index(r=70,P<0.05),while the correlation of total iron binding capacity and perfusion index was weak or negative(r= -0.52,P<0.05).Iron parameters were not related to either perfusion or wall motion indexes in the normocholesterolemic group.Stepwise multiple regression analysis confirmed that the levels of serum ferritin play a sole role in determining myocardial perfusion in patients with HCL (β=0.55,P>0.05).No correlation of iron parameters and the degrees of coronary artery disease was found.Conclusion The rise in iron level is closely related to the myocardial perfusion and the severity and degree of functional abnormalty,but is not related to the range of coronary artery disease in patients with HCL.Enhanced iron-mediated oxidative stress and LDL peroxidation may contribute to hypercholesterolemia-related endothelial dysfunction and may cause greater impairment of perfusion and wall motion.

关 键 词：血清铁蛋白 高血胆固醇症 心肌灌注 室壁运动 

分 类 号：R589.2[医药卫生—内分泌]