静息ST-T改变而冠状动脉造影正常者血清内皮素-1的水平变化

The clinical study of endothelin-1 levels in patients with ST-T changes on electrocardiogram but normal coronary arteriograms

目的测定静息心电图ST-T改变但冠状动脉造影正常的冠心病患者运动负荷试验前后血清内皮素-1(ET-1)水平,初步探讨此类患者的发病机制。方法选取2001-09～2003-03初诊为冠心病的住院患者36例,冠状动脉造影前静息心电图检查均提示ST-T改变,选择性冠状动脉造影检查结果均为阴性。均行运动负荷试验,根据负荷心电图结果将其分为:运动试验阳性组14例(男4例,女10例),运动试验阴性组22例(男10例,女12例)。静息心电图正常运动试验阴性的健康志愿者20名作为对照组(男12名,女8名)。采用ELISA法测定负荷试验前后ET-1浓度。结果冠状动脉造影正常心电图运动负荷试验阳性组运动试验前ET-1水平明显高于阴性组(2.09±0.42ng/Lvs1.79±0.22ng/L,P<0.01)和对照组(2.09±0.42ng/Lvs1.73±0.34ng/L,P<0.01),阴性组与对照组比较无显著性差异(P>0.05)。心电图运动负荷试验阳性组(2.26±0.45ng/Lvs2.09±0.42ng/L,P<0.01)、阴性组穴2.11±0.26ng/Lvs1.79±0.22ng/L,P<0.01雪和对照组穴2.00±0.33ng/Lvs1.73±0.34ng/L,P<0.05雪运动试验后即刻的ET-1浓度与负荷前比较均明显增高,但运动试验后即刻,心电图运动负荷试验阳性组、阴性组和对照组间ET-1浓度无统计学差异(P>0.05)。结论在静息心电图ST-T改变而冠状动脉造影正常的冠心病患?

Objective To investigate the changes of endothelin-1 levels and TIMI frame counts in patients with ST-T changes on electrocardiogram but normal coronary arteriograms.Methods The 36 patients with ST-T changes on electrocardiogram but normal coronary arteriograms were divided into two groups according to the results of exercise test(positive group,n=14;negative group,n=22). There were 20 cases as healthy control group. Their plasma endothelin-1 were measured by ELISA before and after exercise test.Result The endothelin-1 levels in positive group were increased significantly compared with that in negative group(2.09±0.42ng/L vs 1.79±0.22ng/L,P<0.01) and control group(2.09±0.42ng/L vs 1.73±0.34ng/L,P<0.01) before exercise test.No difference was found between the negative group and the control(P>0.05).The endothelin-1 levels after exercise test were much higher than that before exercise test respectively in the three groups(positive group 2.26±0.45ng/L vs 2.09±0.42ng/L,P<0.01;negative group 2.11±0.26ng/L vs 1.79±0.22ng/L,P<0.01;control group 2.00±0.33ng/L vs 1.73±0.34ng/L,P<0.05).After exercise test, the diffrences of endothelin-1 levels in the three groups were not statistically significant(P>0.05).Conclusion Endothelin-1 levels increased at rest in the patients with positive exercise electrocadiogram but normal coronary arteriograms. These data support the hypothesis that there are endothelial microvascular dysfunction in these patients.