冠心病患者血管内皮功能与冠状动脉病变严重程度的关系

Relationship between endothelial function of coronary heart disease and the severity of coronary artery disease.

目的探讨冠心病患者的血管内皮功能改变及其与冠状动脉病变严重程度的关系。方法73例拟行冠状动脉造影术的患者，根据冠状动脉造影结果将其分为冠心病组39例和非冠心病组34例。13例健康、无冠心病危险因素者作为对照组。运用高频线阵超声测定肱动脉流量介导的血管扩张作用指标流量介导血管扩张比（FMD）及硝酸酯介导的血管扩张作用指标硝酸酯介导血管扩张比（NTG—MD），评估患者的血管内皮功能状况，以探讨血管内皮功能与冠状动脉狭窄间的关系。结果冠心病组、非冠心病组和对照组的FMD分别为（4．81±2．33）％、（9．29±3．88）％和（13．58±1．80）％，3组间两两比较差异均有统计学意义（F值为48．012，P〈0．01）；NTG-MD分别为（13．72±3．27）％、（15．64±2．65）％、（16．54±2．98）％，3组间差异有统计学意义（F值为6．015，P〈0．01），冠心痛组与其余2组相比差异均有统计学意义（P均〈0．05）。FMD与管径基础值、冠状动脉受累支数及冠状动脉最大狭窄程度呈负相关（r分别为-0．224、-0．316、-0．721。P分别为0．038、0．003和〈0．001）。NTG-MD与管径基础值、冠状动脉受累支数及冠状动脉最大狭窄程度亦呈负相关（r分别为-0．483、-0．258、-0．372，P分别为〈0．001、0．027、0．001）。多项逐步回归分析显示FMD与冠状动脉最大狭窄程度、管径基础值呈线性关系（r分别为-0．012、-0．022，P均〈0．001）。NTG-MD与管径基础值及冠状动脉最大狭窄程度呈线性关系（r分别为-0．032、-0．0073，P均〈0．001）。结论冠心病患者内皮损害程度与冠状动脉狭窄严重程度之间呈线性相关。

Objective To evaluate the relationship between vascular endothelial function of coronary heart disease and the severity of coronary artery disease （CHD）. Methods 73 patients undergoing coronary angiography were divided into two groups ： CHD group （ n = 39） and non-CHD group （ n = 34） according to the result of coronary angiography. 13 healthy subjects without risk factor of CHD were chosen as normal control group. FMD and NTG-MD of endothelial-dependent and independent dilatation of brachial artery were measured by using of high frequency linear-array ultrasonography for assessment of the vascular endothelial function, and the relationship between the vascular endothelial function and the severity of coronary artery stenosis was analyzed. Results A significant difference was obtained in the FMD among the CHD group,non-CHD group and control group[ （4.81 ± 2.33）% vs. （9.29 ± 3.88） % vs. （ 13.58 ± 1.80） % , F = 48. 012, P 〈 0.01 ）. Significant difference was shown in NTG-MD among the three groups[ （ 13.72 ±3.27） % vs. （ 15.64 ± 2.65） % vs. （ 16.54 ± 2.98） %, F = 6. 015, P 〈 0.01 ] and significant difference was shown between CHD group and the other two group（ P 〈 0.05 ）. The FMD was negatively correlated with the baseline value of the brachial artery, the number of stenotic coronary ateries and the severity of coronary artery stenosis（ r = - 0. 224, - 0. 316, - 0.721 ,P = 0. 038 ,0. 003 and 〈 0.001 ）. NTG-MD was also negatively correlated with the baseline value of the brachial artery, the number of stenotic coronary arteries and the severity of coronary artery stenosis（ r = -0.483, -0.258, -0. 372, P 〈 0. 001,0. 027 ,0. 001 ）. Stepwise regression analysis displayed a linear relationship between FMD and the severity of coronary artery stenosis, the baseline value of the brachial artery（r = -0.012, -0.022,P 〈 0. 001 ）. NTG-MD was linearly related to the baseline value of the brachial artery and the severity of coronary artery stenosis（r = -0.032, -0.0073,P〈0.001）. Conclusion The degree of damage of endothelial function of coronary heart disease is linearly correlated with severity of coronary artery stenosis.