老年冠心病患者血浆同型半胱氨酸水平与内皮依赖性血管舒张功能关系探讨

The relationship between plasma homocysteine levels and endothelium-dependent vasodilatation function in elderly patients with coronary heart disease

目的探讨老年冠心病患者血清同型半胱氨酸(homocysteine,HCY)水平与内皮依赖性血管舒张功能(endothelium-deppendent dilatation,EDD)的相互作用以及与冠心病发病的关系。方法用酶联免疫吸附法(ELISA)测定患者HCY水平,用Celermajer法测定血管内皮功能。结果急性冠脉综合征患者HCY水平明显高于稳定性心绞痛患者和陈旧性心肌梗死患者,血浆HCY水平与血流介导的内皮依赖性的血管舒张呈负相关(r=-0.386,P=0.002),而血浆HCY水平与非内皮依赖性的血管舒张无关(r=-0.076,P=0.553)。急性冠脉综合征患者的EDD%=(4.3±2.9)%明显低于稳定性心绞痛EDD%=(7.4±5.2)%、陈旧性心肌梗死患者EDD%=(6.4±3.0)%(P值分别为0.004,0.004)。而稳定性心绞痛和陈旧性心肌梗死患者之间的EDD无明显差别(P=0.333)。结论高HCY是损伤内皮功能的一个重要的独立因素,测定EDD可以作为反映冠心病患者病情稳定的一项指标。高HCY水平可能通过EDD障碍,影响老年冠心病患者病情的稳定性,参与急性冠脉综合征的发病机制。

Objective To investigate the relationship between plasma homocysteine levels and endothelium-dependent dilatation in elderly patients with coronary heart disease. Methods ELISA method was used todetermine the homcysteine levels. The vascular endothelium-dependent dilatation function was evaluated by eelermajer＇s method. Results The plasma HCY levels in patients with acute coronary syndrome were higher than those in patients with stable angina pectoris and old myocardial infarction significantly. There was a negative correlation between the plasma HCY levels and endothelium-dependent vasodilatation（ r = - 0.386, P = 0.002） ;whereas, there was no correlation between the plasma HCY levels and endothelium-independent vasodilatation（ r = -0.076, P = 0.553）. The endothelium-dependent vasodilatation EDD% = （4.3 ± 2.9） % in acute coronary syndrome group was lower significantly than that in stable angina group, old myocardial infarction EDD% was （6.4 ± 3.0 ） % （ P = 0.004, P = 0.004 respectively）. But there were no differences between stable angina pectoris and old angina pectoris（ P =0.333）.Conclusions The plasma homocysteine（HCY） is an independent risk factor that could damage endothelium. The impairment of endotheliumdependent vasodilatation was caused by the high plasma HCY levels and could affect the stabilization of patients with coronary heart disease, and which might be involved in the mechanism of acute coronary syndrome.