血脂和内皮功能异常在微血管性心绞痛发病学中的意义

The significance of the lipid profile and endothelium dependent vascodilatation function in the pathogenesis of microvascular angina

目的 研究血脂紊乱和血管内皮功能失调在微血管性心绞痛患者发病学中的意义。方法 测定 2 1例微血管性心绞痛患者血脂水平并同时采用高分辨超声技术检测其血管内皮舒张功能 ,与 2 4例正常人 (对照组 )作比较。结果 (1 )微血管性心绞痛组血脂异常主要表现为总胆固醇(TC)、低密度脂蛋白 胆固醇 (LDL C)、载脂蛋白B1 0 0 (ApoB1 0 0 )和脂蛋白 (a) [Lp(a) ]明显升高 (P值均 <0 0 5 ) ;(2 )微血管性心绞痛组肱动脉血流介导性内皮舒张功能较对照组明显减退 [(4 7± 1 9) %比(1 2 8± 3 7) %,P <0 0 0 1 ],而两组对硝酸甘油的反应差异无显著性意义 [(1 9 7± 8 1 ) %比 (2 1 2±6 6 ) %,P >0 0 5 ];(3 )微血管性心绞痛组肱动脉内皮依赖性舒张与血清LDL C和Lp(a)水平呈显著的负相关 (r=- 0 5 1 2 5和 - 0 42 71 ,P均 <0 0 0 1 )。按血流介导的肱动脉舒张程度将两组合并后分为A、B两组 (A组≤ 4 %,B组 >4 %) ,结果显示 :A组LDL C水平升高显著 [(4 0 9± 0 6 5 )mmol/L比 (2 5 9± 0 49)mmol/L ,P <0 0 5 ]。结论 (1 )微血管性心绞痛患者血脂异常以TC、LDL C、ApoB1 0 0 和Lp(a)升高为主 ,同时存在明显的血管内皮依赖性舒张功能障碍 ,提示血脂紊乱和内皮功能异常在其发病中起重要作用 ;

Objective To study the Significance of the lipid profile and endothelium dependent vasodilatation function in the pathogenesis of microvascular angina Methods The concentration of plasma lipid, lipoprotein and apolipoprotein levels was assayed in 21 patients with microvascular angina and 24 healthy subjects The endothelium dependent vascodilatation function was also measured by high resolution ultrasound in the two groups Results (1)The serum total cholesterol (TC), LDL Cholesterol(LDL C), apolipoprotin B 100 (ApoB 100 ) and lipoprotein (a) levels in microvascular angina patients were significantly higher than those in healthy subjects (all P <0 05) (2) The flow mediated dilatation (FMD) in brachial arteries in microvascular angina patients was much lower compared with that in the healthy subjects[(4 7±1 9)% vs (12 8±3 7)%, P <0 001]. However, there was no significant difference in response to nitroglycerin between the two groups [(19 7±8 1)% vs (21 2±6 6)%, P >0 05] (3) Linear correlation analysis showed that FMD of brachial arteries was negatively correlated with the LDL C and Lp(a)( r = 0 512 5 and 0 427 1, respectively, P both <0 001) in microvascular angina All subjects were divided into two groups (group A and B) according to the degree of FMD of brachial arteries (The FMD of brachial arteries was ≤4% in group A and >4% in group B). The serum LDL C level in group A was significantly higher than that in group B [(4 09±0 65)mmol/L vs (2 59±0 49)mmol/L, P <0 05] Conclusion (1) TC, LDL C, ApoB 100 and Lp(a) levels in microvascular angina patients were significantly higher than those in healthy subjects (2) The disorder lipid profile and endothelium dependent vasodilatation dysfunction might play an important role in microvascular angina process (3) The endothelium dependent vasodilatation dysfunction in microvascular angina was mainly influenced by LDL C and Lp(a) in lipid profile, and myocardial endothelial dysfunction was aggravated by disorder lipid profile in microvascular angina