培垛普利对冠心病患者经皮冠状动脉介入术后肱动脉内皮功能障碍的影响

Influence of perindopril on percutaneous coronary intervention-induced brachial artery endothelial dysfunction in coronary artery disease patients

目的探讨培垛普利对经皮冠状动脉介入(PCI)操作所诱发的肱动脉内皮功能不全的影响。方法实行PCI的冠心病患者62例,随机分为2组,培垛普利组31例,对照组31例,应用高频超声探头分别测量2组PCI术前及术后的肱动脉基础内径、反应性充血内径、含服硝酸甘油后内径,计算肱动脉血流介导的舒张反应(FMD),并运用多普勒技术测定血流速度峰值,最后比较2组间及组内上述参数的差异。超声测量于PCI术前2h和术后30min内完成。结果培垛普利组的FMD明显改善〔(5.9±0.3)%术前vs(7.7±0.4)%术后PCI,P<0.001〕,而对照组明显恶化〔(6.0±0.5)%术前vs(4.8±0.6)%术后PCI,P<0.001〕。两组硝酸甘油介导的血管舒张反应及反应性充血血流速度峰值均无明显变化。结论培垛普利可改善PCI介导的肱动脉内皮功能不全。

Objective To investigate the influence of perindopril on endothelial dysfunction of the brachial artery induced by percutaneous coronary intervention （PCI）. Methods Sixty-two patients with coronary artery disease who underwent elective PCI were randomly divided into two groups： perindopril group（n= 31） and control group（n= 31）. The baseline diameter of brachial artery, the reactive hyperemia diameter and the diameter after sublingual nitro- glycerin （NTG） before and after PCI were respectively examined by high-resolution ultrasonic transducer and flow-mediated dilation （FMD） as the percent change in the brachial artery in response to hyperemia was calculated. At the same time, the maximum blood flow velocity at rest and during reaetive hyperemia was also determined by pulsed-Doppler signals. The above parameters were respectively compared in two groups and between groups. All patients were examined within 2h before and within 30 min after completion of PCI. Results Perindopril significantly im proved FMD[（5. 9±0. 3）% before vs （7.7±0.4）% after PCI, P〈0. 0013, whereas there was impaired FMD in the patients of the control group[（6.0±0.5）% before vs （4.8±0.6）% after PCI, P〈0. 0013. The vasodilation reaction induced by NTG and the maximum blood flow velocity of reactive hyperemia in the two groups remained unaltered. Conclusion Perindopril can improve endothelial dysfunction of the brachial artery during PCI.