超声心动图测定冠状动脉内皮功能的临床研究

Clinical research of echocardiography determining the endothelium function of coronary artery

目的探讨经胸超声心动图技术结合干预试验测定冠心病患者冠状动脉内皮功能的方法。方法冠状动脉造影（CAG）正常或管腔直径狭窄〈50％且无冠心病易患因素者为对照组（32例）；至少1支冠状动脉主支或其主要分支（对角支、钝缘支和后降支）狭窄≥50％即诊断为冠心病，纳入观察组（26例）。用体表超声心动图显示右冠状动脉，在二维指导下M型分别测定基础、冷加压、复温及舌下含服硝酸甘油时右冠状动脉内径变化，并计算各组冷加压和含服硝酸甘油干预后内径增加率。结果冷加压干预后，对照组的内径增加率明显大于观察组，组间比较差异有统计学意义[（24．3±1．4）％比（7．7±1．0）％，P〈0．01]。硝酸甘油干预后，对照组内径增加率高于观察组，但组间比较差异无统计学意义[（24．5±1．5）％比（19．8±1．8）％，P〉0．05]。结论冠心病患者存在着内皮依赖性的舒张作用消失，本方法可区分出冠心病和非冠心病患者冠状动脉内皮依赖和非依赖性舒张状态，为体表超声心动图直接测定冠状动脉内皮功能提供参考。

Objective To explore a way to determine endothelium function of coronary heart disease （CHD） by echocardiography combined with intervention experiment. Methods The control group consisted of 32 subjects with no risk factors for coronary artery disease ; The observation group consisted of 26 subjects diagnosed of CHD by coronary arteriongraphy with coronary arteries stenosis more than 50%. All subjects were exanlined by echo- cardiography to record variation of the right coronary artery（RCA） diameter which responses to resting condition, cold pressor test and sublingual nitroglycerin. The changes of right coronary artery diameter were calculated. Results After cold pressor test, the increase rate of diameter in control group was more significant than that in observation group [ （24. 3 ± 1. g） % vs （7.7 ± 1.0） % , P 〈 0. 01 ] ; there was no significant difference about the increase rate of. diameter between control group and observation group after nitroglycerin. Conclusions Patients with CI-ID can have the coronary endothelium-dependent dilatation, which can distinguish patients with CHD and patients without CHD in coronary endothelium function. This method can be conveniently used to evaluate endothelium function by echo- cardiogram.