调脂治疗对冠心病患者餐后血管内皮功能的影响  

Influence of lipid-modulating therapy on high-fat diet induced endothelial dysfunction in patients with coronary heart disease

作　　者：程艳春[1] 赵水平[1] 刘玲[1] 刘明辉[2] 李玉玲[3] 

机构地区：[1]中南大学湘雅二医院心内科 [2]中南大学湘雅二医院超声科,长沙410011 [3]中南大学湘雅二医院营养科,长沙410011

出　　处：《中华心血管病杂志》2004年第2期114-117,共4页Chinese Journal of Cardiology

摘　　要：目的　旨在通过高脂餐试验 ,研究调脂治疗对冠心病患者餐后血管内皮功能变化的影响。方法　 5 0例来源于我院心血管内科门诊和住院的冠心病患者。经饮食宣教 4周后 ,开始高脂餐试验和采用高分辨血管外超声法检测肱动脉血流介导的内皮依赖性血管舒张功能 (FMD)。随后将受试者随机分为常规治疗组和血脂康组。治疗 6周后重复上述检查。结果　治疗前两组高脂餐后 4h的FMD明显受损 (P <0 0 5 ) ,餐后血清甘油三酯 (TG)浓度明显升高 (P <0 0 5 ) ,两组间餐后甘油三酯曲线下面积 (TG AUC)差异无显著性。 6周后血脂康组餐前和餐后FMD有明显改善 (P <0 0 5 ) ,且空腹FMD和餐后FMD差异无显著性 ,而常规治疗组空腹FMD和餐后FMD较治疗前无明显变化 ,餐后FMD仍显著受损 (P <0 0 5 )。相关分析显示餐后TG AUC与餐后 4h内皮依赖性血管舒张功能下降值正相关 (r=0 32 2 ,P <0 0 5 )。治疗后TG AUC的变化与空腹和餐后FMD的变化显著相关 (P <0 0 1)。结论　高脂餐后冠心病患者血管内皮功能受损 ,可能与餐后血脂紊乱有关。提示血脂康调脂治疗有效改善冠心病患者空腹和高脂餐后血管内皮功能。Objective To investigate the influence of lipid-modulating therapy on postprandial endothelial function after a high-fat meal in patients with coronary heart disease (CHD). Methods Fifty patients with CHD were recruited in this study after four weeks diet control. Flow-mediated dilation (FMD) was assessed by Doppler flow in the brachial artery before and 4 hours after a high-fat meal. They were randomly divided into conventional group and Xuezhikang group (0.6 g twice per day). After six weeks of treatment, above-mentioned high-fat diet test and endothelial function examination were repeated. Results The postprandial FMD in two groups were impaired significantly at 4 hours (P<0.05). The serum triyglyceride levels increased significantly at 2,4,6 hours (P<0.05). There was no difference in the area under triglyceride curve (TG-AUC) over 6 hours between conventional group and Xuezhikang group. After 6 weeks the fasting and postprandial FMD improved obviously in Xuezhikang group (P<0.05), and the postprandial FMD did not aggravated significantly. While there was no significantly change in the fasting and postprandial FMD in conventional group, and the postprandial FMD obviously aggravated after 6 weeks. By correlation analysis, the postprandial change of FMD was correlated with TG-AUC over 6 hours (r=0.322,P<0.05). And the change of TG-AUC was significantly related to the changes of fasting FMD(r=0.497, P<0.01) and postprandial FMD (r=0.417,P<0.01)after 6 weeks. Conclusion The CHD patients had significant impairment of FMD after a high-fat meal, which was related to the postprandial dyslipidemia. Lipid-modulating therapy effectively improves endothelial function at the fasting and postprandial state in patients with CHD.

关 键 词：调脂 治疗 冠心病 餐后 血管内皮功能 血管舒张 高脂血症 

分 类 号：R541.4[医药卫生—心血管疾病]