高分辨率超声评价高脂血症患者肱动脉内皮功能(英文)

Evaluation of brachial artery endothelial function in patients with hyperlipidemia using high-resolution ultrasound

背景:以往对血管内皮依赖性舒张功能的评估采用冠状动脉内直接输注乙酰胆碱和数字性血管造影的方法,但这种有创性检查限制了对疾病早期发生、发展及临床干预治疗后的动态观察。目的:探讨利用高分辨率超声评估高脂血症患者肱动脉内皮依赖性舒张功能的变化,并与健康者进行对照。设计:病例-对照。单位:一所市级医院超声科和心内科。对象:选择2001-05/2002-03信阳市中心医院心内科收治的高脂血症患者60例,男37例,女23例;年龄36～75岁。根据患者血脂情况将患者分为3组:高胆固醇血症组20例,高三酰甘油血症组20例,混合性高脂血症组20例。选择同期健康体检志愿者20人为正常对照组,男12人,女8人。所有纳入对象均知情同意。方法:肱动脉内径及血流量变化测量采用使用高分辨率超声诊断系统。患者休息至少10min后测量安静时肱动脉内径及基础血流量。然后用袖套式充气带在肘关节以下加压300mmHg,持续四五分钟,突然放气,测量放气后15s时的血流介导的肱动脉内径及反应性充血血流量。再休息至少15min,待血管完全恢复正常后,于舌下含服硝酸甘油400μg,三四分钟后,再次测量含服硝酸甘油后肱动脉内径及含服硝酸甘油后血流量。然后计算反应性充血后肱动脉内径较基础内径变化的百分率=(血流介导的肱动脉内径-安静时肱动脉内径)/安静时肱动脉内径×100%;含服硝酸甘油后肱动脉内径较基础内径变化的百分率=(含服硝酸甘油后肱动脉内径-安静时肱动脉内径)/安静时肱动脉内径×100%。反应性充血血流量增长百分率=反应性充血血流量/基础血流量×100%;含服硝酸甘油后血流量增长百分率=含服硝酸甘油后血流量/基础血流量×100%。主要观察指标:应用高分辨率超声仪器观察3组高脂血症患者和正常对照组体检者静息状态下、反应性充血时、舌下含服硝酸甘油后的肱动脉内径变化。结果:高脂血症患者60例和健康体检者20人均进入结果分析。高胆固醇血症组、高三酰甘油血症组、混合性高脂血症组患者反应性充血后肱动脉内径较基础内径变化的百分率明显低于正常对照组犤(5.7±3.2)%,(5.4±3.0)%,(3.8±2.4)%,(11.3±3.1)%,P<0.05犦,其中以混合性高脂血症患者降低最明显。而3个患者组反应性充血及含服硝酸甘油后血流量增长百分率,以及含服硝酸甘油后肱动脉内径较基础内径变化的百分率差异不明显(P>0.05)。结论:高脂血症患者血管内皮依赖性舒张功能较正常人明显受损,高分辨率超声能准确可靠地检测血管内皮依赖性舒张功能。

BACKGROUND： Endothelium-dependent vasodilatation （EDD） has been assessed by intracoronary acetylcholine infusion and digital subtraction angiography. However, its applications in continuous observing on early onset, progression and outcomes of clinical interventions of the disease are limited due to the potential trauma of the method. OBJECTIVE： This study was designed to assess the changes in brachial EDD in patients with hyperlipidemia using high-resolution ultrasound and to compare the outcomes of the patients to those of the healthy individuals. DESIGN： Case-control studySETTING： This study was carried out at the Cardiology Department and the Ultrasound Department of Xinyang Central Hospital PARTICIPANTS： Sixty patients with hyperlipidemia, 37 males and 23 females, with an age ranging from 36 to 75 years old, were selected at the Cardiology Department of Xinyang Central Hospital from May 2001 to March 2002. They were divided into 3 groups according to abnormalities in blood lipid, as hypereholesterolemia group （HC, 20 eases）, hypertriaeylglyeerolemia group （HTG, 20 cases） and mixed hyperlipidemia group （HLP, 20 eases）. Twenty voluntary individuals with normal physical examination findings were allocated into control group, 12 males and 8 females. Informed consents were obtained from all the eligible. METHODS： The braehial artery inner diameter and the changes in blood flow of the braehial artery were assessed using high-resolution ultrasound. After the patients having a rest for more than 10 minutes, the inner diameter （Do） and the baseline blood flow of their braehial artery were measured. The blood pressure cuff was placed under the elbow with a pressure at 300 mmHg, lasting for 4 to 5 minutes and followed with a sudden deflation. 15 s after deflation, the reactive brachial artery inner diameter （D1） and the blood flow of the braehial artery were detected. The patients took another rest for more than 15 minutes and after the artery restored to a normal condition, the patients took nitroglyeerol sublingnally at a dose of 400 lag. Three to four minutes later, the brachial artery inner diameter （D2） and the blood flow of the braehial artery were detected. The increasing rate of the inner diameter of braehial artery were calculated, the increasing rate of reactive braehial artery inner diameter （%）= （D1-D0）/D0×100% and the increasing rate of post-treatment braehial artery inner diameter （%） =（D2-D0）/D0 × 100%. Meanwhile, the increasing rate of reactive blood flow （%）=（reactive blood flow-baseline blood flow）/ baseline blood flow （100% and the increasing rate of post-treatment blood flow （%）=（the post-treatment blood flow-baseline blood flow）/baseline blood flow×100%. MAIN OUTCOME MEASURES：In three hyperlipidemia groups and the control group, the inner diameter of the brachial artery were measured under resting conditions, in reactive congestion status and after sublingnal nitrogiyeerol treatment respectively using high-resolution ultrasound. RESULTS： All the 60 patients with hyperlipidemia and 20 healthy controis entered the analysis procedure. In HC group, HTG group and HLP group, the increasing rate of reactive brachial-artery inner diameter were significantly lower than that in control group [（5.7±3.2）%, （5.4±3.0）%,（3.8±2.4）%, （ 11.3±3.1 ）% ,P 〈 0.05], which was most significant in HLP group. The increasing rate of both the reactive and the post-treatment blood flow in three experimental groups and the increasing rate of the post-treatment brachial-artery inner diameter were not significant （P 〉 0.05）. CONCLUSION：EDD were impaired significantly in patients with hyperlipidemia. High-resolution ultrasound is capable of assessing EDD accurately and reliably.