冠心病患者血管内皮功能障碍及动脉弹性与冠状动脉Gensini评分的关系

Association between Gensini score and impaired endothelium-dependent vasodilation or arterial elasticity in patients with coronary artery disease

目的:探讨冠心病患者血管内皮功能障碍及动脉弹性与冠状动脉造影Gensini评分的关系。方法:采用高分辨率血管超声法检测冠心病患者(76例)与正常对照组(30例)肱动脉血流介导的内皮依赖性血管舒张功能(FMD);应用动脉弹性功能检测仪测定受试者的大动脉弹性指数(C1)和小动脉弹性指数(C2);对冠心病患者进行冠状动脉造影,并通过Gensini评分系统对冠心病患者冠状动脉病变进行评分。结果:冠心病组血流介导的FMD明显低于对照组[(6.94±4.21)%:(11.10±4.36)%,P<0.05];冠心病组与对照组的C1差异无统计学意义[(117.0±38.1):(121.1±38.2)ml/mmHg(1mmHg=0.133kPa),P>0.05],但冠心病组的C2明显低于对照组[(516.0±264.0):(626.0±236.0)ml/mmHg,P<0.05],冠心病患者FMD及C2均与冠状动脉造影Gensini评分呈负相关(r=-0.380,P<0.01及r=-0.329,P<0.01)。结论:C2和FMD似可作为评价冠状动脉病变程度的新指标。

Objective： To investigate the change in endothelium-dependent vasodilation and arterial elasticity and the association between Gensini score and impaired endothelium-dependent vasodilation or arterial elasticity in patients with coronary artery disease （CAD）. Method： Seventy six patients with CAD and thirty nomal controls were recruited for this study. Flow-mediated dilation （FMD） in the brachial artery was evaluated by ultrasound Doppler flow method. They also underwent a noninvasive assessment of C, large artery and C2 small artery indices by using pulse wave analysis. And the patients with CAD underwent coronary arteriography. Gensini score was used to evaluate the pathological change degree of coronary artery in the patients with CAD. Result：FMD was significantly reduced in CAD group compared with that in control group（[6.94±4. 211% vs [11.1 ±4.36]% , P〈 0. 05, [117.0±38. 1] vs [121.1±38.2]ml/mmHg, P〉0.05）. However, C2 small artery elasticity index was significantly reduced in CAD group compared with that in control group（ [516.0±264.0] vs [626.0±236.0]ml/ mmHg, P〈0. 05）. There was a negative association between impaired FMD and increased pathological change degree of coronary artery （r= -0. 380, P〈0.01）. There was also a negative association between reduced C2 small artery elasticity index and increased pathological change degree of coronary artery （r= -0. 329, P〈0. 01 ）. Conclusion：There were impaired endothelium-dependent vasodilation and reduced C2 small artery elasticity index in the patients with CAD. There was a negative association between increased pathological change degree of coronary artery and impaired FMD or reduced C2 small artery elasticity index. The present study suggested that the measurement of FMD or C2 small artery elasticity might be used as a novel index for the determination of the pathological change degree of coronary artery.