冠心病患者冠脉循环ox-LDL水平与内皮依赖舒张功能关系的研究

Relationship between blood ox-LDL levels in coronary sinus and impaired endothelium-dependent vasodilation in patients with coronary artery disease

目的探讨冠心病患者冠脉循环ox-LDL变化与内皮依赖舒张功能的变化及临床意义。方法临床及选择性冠状动脉造影确定冠心病患者96例,其中急性心肌梗死(AM I)22例,不稳定性心绞痛(UA)29例,稳定性心绞痛(SA)25例,排除冠心病组20例;利用心导管技术采其冠状窦血通过夹心双抗酶联免疫法测定氧化低密度脂蛋白(ox-LDL),利用高分辨率超声测肱动脉反应性充血引起的流量介导血管扩张(FMD)与硝酸甘油介导的血管扩张(NTG)。结果冠心病组患者冠状窦血中ox-LDL水平均明显增高(P<0.01)。AM I组、UA组量较SA明显增高(P<0.01)。AM I组较UA组明显增高(P<0.05)。冠心病组FMD均降低(P<0.05),AM I、UA两组相比无显著差异(P>0.05)。AM I、UA组与SA相比有显著差异(P<0.05),而NTG在3组之间无显著差异(P>0.05)。结论冠心病患者冠脉局部ox-LDL升高,过氧化所致血管内皮功能损伤,内皮依赖舒张功能降低,可能参与其发病过程及临床表现。

Objective To investigate the relationship between the oxidized low-density lipoprotein （ox- LDL） in the blood from the coronary sinus and impaired endothelium-dependent vasodilation in patients with coronary artery disease （CHD）. Methods Four groups of patients were subjected, including acute myocardial infarction group （AMI, n = 22）, unstable angina group（ UA, n = 29）, and stable angina group （SA, n = 25 ） and control group （ n = 20 ） who was first suspected as CHD and then verified with normal coronary angiograms. Blood form the coronary sinus was collected through cardiac cathetering and the ox-LDL level was measured by Sandwich ELISA method. Brachial arterial hyperemia-induced flow mediated dilation （FMD） and sublingual nitroglycerin （NTG） mediated vasodilation were measured by high resolution ultrasound. Results The blood level of ox-LDL in patients with CHD was markedly higher than those in control group （P 〈 0. 01 ）, with those of AMI and UA significantly higher than those of the SA group （ P 〈 0. 01 ）, and those of AMI group higher than those of UA group （P 〈 0. 05 ）. Compared with control group, the FMD in CHD group was significantly decreased （ P 〈 0. 05 ） , but no significantly difference was seen in NTG between the CHD and control groups. As for the FMD, there was no difference between in AMI and UA groups, though these 2 groups were lower than SA group （P 〈0. 05）. Conclusions In the CHD patients, their blood ox-LDL level in coronary sinus is increased and FMD is decreased, indicating that ox-LDL and endothelium-dependent vasodilation may be one of the pathophysiological basis of acute coronary syndrom.