心绞痛患者心脏局部血管紧张素Ⅱ与冠状动脉病变危险分数的关系

Cardiac angiotensin Ⅱand jeopardy score of coronary artery lesion by angiography in angina patients

目的 :检测心绞痛患者心脏局部血管紧张素Ⅱ (AngⅡ )的浓度 ,选择性冠状动脉造影评估冠状动脉病变的危险分数 ,分析心脏局部血管紧张素Ⅱ (AngⅡ )与危险分数的相关性。方法 :37例心绞痛患者均经冠状动脉造影证实有明显冠状动脉狭窄 ;18例正常对照者经临床检查和选择性冠状动脉造影排除冠心病。在经皮冠状动脉介入手术中采集主动脉、冠状窦和外周血液标本 ,测定主动脉与冠状窦血液中AngⅡ的浓度 ,计算二者之间的差值 ,以此代表心脏局部产生的AngⅡ浓度 ,同时测定外周血中AngⅡ浓度。按照Califf介绍的危险分数评价选择性冠状动脉造影冠状动脉病变情况。结果 :心绞痛患者尤其是不稳定型心绞痛患者心脏局部和外周血中AngⅡ浓度均明显增高 (P <0 .0 1) ,心脏局部AngⅡ浓度与危险分数呈明显正相关 (P <0 .0 1) ,不稳定型心绞痛患者外周血AngⅡ浓度与危险分数呈明显正相关 (P <0 .0 5 ) ,稳定型心绞痛患者外周血AngⅡ浓度与危险分数无明显相关性。结论 :心脏局部AngⅡ浓度与冠状动脉病变危险分数密切相关 ,心脏局部AngⅡ可能在动脉粥样硬化和冠心病的发生发展中起重要作用。冠状动脉造影所见的冠状动脉病变结合检测心脏局部AngⅡ浓度 。

Objective: To investigate the expression of cardiac angiotensinⅡ(AngⅡ), the jeopardy score of coronary artery lesion by angiography, and their correlations in patients with stable angina (SA) or unstable angina (UA). Method: The 20 patients with UA, 17 patients with SA and 18 patients excluding coronary heart disease (control) were studied. Blood samples were collected during percutaneous coronary intervention (PCI). The aorta-coronary sinus gradient of was measured as cardiac AngⅡconcentration. The AngⅡ concentration of peripheral blood was also measured. The jeopardy score for coronary artery lesion was evaluated according to the method by Califf. Result: Either cardiac or peripheral AngⅡconcentration in angina patients, especially in UA patients was higher than that in control group (P< 0.01), but the jeopardy score showed no difference between UA and SA. The cardiac AngⅡ showed a closely positive correlation with jeopardy score (P< 0.01).The peripheral AngⅡshowed a positive correlation with jeopardy score (P< 0.05) in UA, while no obvious correlation was observed in SA. Conclusion: The cardiac AngⅡmay play as a aggravating factor in the pathophysiological progress of atherosclerosis and coronary heart disease. Coronary angiography combined with detection of cardiac AngⅡconcentration may better describe the lesion of coronary artery, and may better evaluate the prognosis of coronary heart disease patients.