血浆不对称二甲基精氨酸水平与冠状动脉硬化关系的研究

Relationship between plasma asymmetrical dimethylarginine and coronary artery disease

目的研究不对称二甲基精氨酸(ADMA)水平是否与冠状动脉粥样硬化的病变范围和严重程度有关。方法 110例行冠状动脉造影术的患者根据造影结果分为冠状动脉造影正常的对照组22例,轻度动脉硬化组21例,造影显示冠状动脉内膜不光滑,但无明显的狭窄或狭窄小于50%;单支病变组22例,造影显示1支主要的冠状动脉分支出现明显狭窄(≥50%);双支病变组22例,两支主要的冠状动脉分支出现明显狭窄;多支病变组23例,两支以上主要的冠状动脉分支出现明显狭窄或伴有左主干病变。血浆 ADMA 水平的检测采用酶联免疫法。结果除轻度动脉硬化组 ADMA水平(1.21μmol/L±0.36μmol/L,P=0.288)偏低外,单支病变组、双支病变组和多支病变组患者的ADMA 水平均高于对照组(1.52μmol/L±0.61μmol/L,1.67μmol/L±0.80μmol/L 和2.60μmol/L±0.62μmol/L vs 0.79μmol/L±0.54μmol/L,P<0.01)。经过多元相关与 Logistic 等级回归分析,ADMA 水平与冠状动脉病变程度密切相关。结论血浆 ADMA 水平升高可以预测冠状动脉粥样硬化的发生,ADMA 可能是一种新的冠心病危险因子。

Objective To investigate whether the plasma asymmetrical dimethylarginine （ADMA） level correlates with the extent and severity of coronary atheroselerosis. Methods 110 eonseeutive patients undergoing coronary angiography were divided into five groups according to the result thereof： control group （n = 22, with normal eoronary artery ） , mild eoronary artery disease （CAD） group （n = 21, with stenosis 〈 50% of the major eoronary arteries ） , single braneh CAD group Ⅲ （ n = 22, with stenosis ≥ 50% of one major eoronary artery） ; double braneh CAD group Ⅳ （n = 23, with stenosis ≥50% of two major coronary arteries） ; and multi-branch CAD group （ n = 22, with significant stenosis ≥50% of more than two major coronary arteries or eompanied with stenosis of left major coronary）. ELISA was used to detect the plasma ADMA. Nitrie acid reduetase method and eolorimetry were used to measure the levels of plasma nitric oxide （NO） and nitrogen oxide synthase （NOS）. The relationship between the plasma ADMA and severity of CAD was analyzed. Results The plasma ADMA levels of in last three a groups were 1.52 μmol/L ± 0.61 μmol/L, 1.67 μmol/L ± 0.80 μmol/L, and 2.60 μmol/L ± 0.62 μmol/L all signifieantly higher than that of the eontrol group （0.79 μmol/L ± 0.54 μmol/L, P 〈 0.01 ）. The plasma NO and NOS levels of the multi-branch CAD group were signifieantly lower than those of the other groups （all P 〈 0.01 ） , and there were not significant differences in Plasma NO and NOS levels among the other groups. Multivariate stepwise logistic regression analysis showed that the plasma ADMA level was significantly positively correlated with the severity of eoronary atheroselerosis （ r = 0.684, P = 0. 007 ） and total eholesterol and triglyeeride （ r = 0. 623 and 0.536 respeetively ）, and significantly negatively correlated with the NO and NOS levels （ r ： - 0. 709 and - 0. 701 respectively ）. Conclusion Correlated significantly with the severity of coronary atheroselerosis, the plasma ADMA level may beeome a novel marker of CAD.