原发性高胆固醇血症血管内皮依赖性舒张功能失调的无创性检测

Non-invasive Detection of Endothelial Dysfunction in Patients with Primary Hypercholesterolemia

采用无创性高分辨超声技术，检测了１７例无症状的原发性高胆固醇血症患者和１７例血浆胆固醇水平正常的对照者在基础状态下，反应性充血及含服硝酸甘油后肱动脉的内径变化。结果显示，前者血流介导性肱动脉舒张较正常组明显减弱（５．９％±２．３％比１４．５％±３．４％，Ｐ＜０．００１）；血流介导性肱动脉舒张与血总胆固醇（ＴＣ）及低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）呈显著负相关（相关系数ｒ分别为－０．６４２及－０．６２３，Ｐ＜０．００１）；而两组对硝酸甘油的反应差异无显著性（２４．５％±４．３％比２３．０％±７．０％，Ｐ＝０．４９）。结果表明，原发性高胆固醇血症患者血管内皮依赖性舒张功能明显受损，ＬＤＬ－Ｃ升高是内皮依赖性舒张功能障碍主要的独立危险的因素。

With high-resolution ultrasound,the diameter of the brachial arteries at rest was measured,during reactive hyperaemia,and after sublingual glyceryl trinitrate (GTN) in 34 subjects,consisting of 17 controls with normal blood cholesterol and 17 patients with established primary hypercholesterolemia.The results showed that in patients with primary hypercholesterolemia,flow-mediated dilation in arteries was much reduced for comparison with control group (5.9%± 2.3% vs 14.5%±3.4%,P<0.001).Flow-mediated dilation was inversely related with both total and LDL-cholesterol values in all population subjects (r= -0.642 , and r=-0.623,P<0.001 respectively).However,there was no significant difference in response to GTN between two groups (24.5%±4.3% vs 23.0%±7.0%,P=0.49).It is concluded that endothelium-dependent vasodilation is impaired in patients with primary hypercholesterolemia,and elevated LDL-cholesterol is the major risk factor of endothelial dysfunction.