老年冠心病合并糖尿病患者血管内皮功能的变化

Changes in the vascular endothelial function of the elderly coronary heart disease patients with diabetes

目的探讨老年冠心病患者以及冠心病合并糖尿病患者肱动脉内皮依赖性舒张功能（EDD）、非内皮依赖性舒张功能（EID）、血浆一氧化氮（NO）、内皮素（ET）的水平，为临床防治提供依据。方法采用高分辨率超声诊断系统分别检测35例老年冠心病患者（冠心痛组，年龄62～91岁）以及32例老年冠心病合并糖尿病患者（冠心病合并糖尿病组。年龄65-89岁）肱动脉的EDD及EID；同时采用还原、比色法测定NO水平；采用放射免疫法检测ET水平，并分别与40例健康老年人（健康对照组，年龄61～86岁）进行对比。结果老年冠心病合并糖尿病组肱动脉的EDD、EID以及血浆NO水平均显著低于老年冠心病组和健康对照组（P〈0．05），而老年冠心病组的EDD、EID以及血浆NO水平亦显著低于健康对照组（P〈0．05）；老年冠心病合并糖尿病组的ET却显著高于老年冠心病组和健康对照组（P〈0.05），老年冠心病组ET水平显著高于健康对照组（P〈0．05）。结论（1）老年冠心病及冠心病合并糖尿病组肱动脉EDD及EID均受损；（2）老年冠心病及冠心病合并糖尿病组均存在血管内皮功能失调，且冠心病合并糖尿病组内皮功能紊乱更严重；（3）改善血管内皮功能、控制血糖是减少心血管事件的重要措施之一。

Objective To investigate the vascular endothelial function of the elderly coronary heart disease （CHD） patients and CHD patients with diabetes. Methods The endothelium-dependent dilation （EDD）and endothelium-independent dilation（EID）of 35 elderly CHD patients and 32 elderly CHD patients with diabetes were examined by the color Doppler ultrasonograph and compared with 40 old healthy controls. The plasma concentration of nitric oxide（NO） and endothelin（ET） were examined in the above subjects. Results （1）Both EDD and EID of the brachial artery in the old CHD patients with diabetes were lower than those in old healthy controls and old CHD patients significantly（ P 〈 0.05）. （2）The plasma level of NO in the old CHD patients with diabetes was the lowest, but the ET level was the highest. Conclusions （ 1 ） Both EDD and EID of the old CHD patients and CHD ones with diabetes are impaired. （2） Dysfunction of vascular endothelium exists in the old CHD patients and CHD ones with diabetes. （3）Attention should be paid to ameliorate the endothelial function and control the level of blood sugar in the prevention of cardiovascular events.