内皮功能异常在X综合征患者中的发病学意义

The significance of endothelial dysfunction in the pathogenesis of syndrome X

目的 研究内皮功能异常在X综合征患者中的发病学意义。方法 测定了 15例X综合征患者胸痛发作前后血中循环内皮细胞数 (CEC)和内皮素 (ET) 1含量 ,并采用高分辨超声技术检测其血管内皮依赖性舒张功能的变化 ,与 2 0例正常人进行对照。结果 ( 1)X综合征患者CEC数及ET 1水平明显高于正常对照组 (P值均 <0 0 1)。ET 1含量与CEC数变化呈显著的正相关 (r =0 6 7,P <0 0 1)。 ( 2 )X综合征患者胸痛发作时的CEC数及ET 1含量与胸痛前、胸痛发作后比较有明显差异 (P值均 <0 0 1)。 ( 3)X综合征组肱动脉血流介导性舒张较正常组明显减弱 [( 4 2± 2 1) %比( 13 6± 3 2 ) % ,P <0 0 0 1],而两组对硝酸甘油的反应差异无显著性 [( 2 1 6± 7 8) %比 ( 2 2 8± 4 7) % ,P >0 0 5 ]。肱动脉内皮依赖性舒张功能变化与CEC数和ET 1含量呈显著的负相关 (r=- 0 7146 ,- 0 732 8,P值均 <0 0 0 1)。结论 X综合征患者存在明显的血管内皮损伤及血管内皮依赖性舒张功能障碍 ,并与胸痛发作有密切关系 。

Objective To investigate the role of endothelial dysfunction in the pathogenesis of syndrome X Methods The number of circulation endothelial cells (CEC) and the concentration of plasma endothelin1 (ET1) were assayed in 15 patients with syndrome X and 20 healthy subjects The endotheliumdependent relaxing function was also measured with highresolution ultrasound in the two groups Results (1)The number of CEC and levels of plasma ET1 in the patients with syndrome X were much higher than those in the healthy subjects (P<001) The ET1 levels were significantly correlated with the CEC number(r=067, P<001) (2)The CEC number and ET1 values during the attack of angina were significantly higher than those before and after angina (P<001) (3)In patients with syndrome X, flow mediated dilation in artery was much reduced as compared with that in the healthy subjects [(42±21)% vs (136±32)%, P<0001] However, there was no significant difference in response to nitroglycerin between the two groups [(216±78)% vs (228±47)%, P>005] The changes of endotheliumdependent relaxing function in artery were negatively correlated with the CEC and ET1 values(r=-07146, -07328,P<0001) Conclusions In patients with syndrome X, there were endothelial lesion and endotheliumdependent vasodilatation dysfunction Attack of angina in the patients was related closely to the injury of vascular endothelia It is suggested that the decrease of coronary flow reserve in the patients may be a manifestation of systemic vascular dysfunction which plays an active role in the disease process