冠状动脉慢血流与冠脉内局部内皮素-1和一氧化氮浓度的关系及临床因素分析

目的探讨冠状动脉慢血流与冠脉内局部内皮素-1(ET-1)和一氧化氮(NO)浓度的关系及引起慢血流的临床因素分析。方法选取有心绞痛症状同时运动试验阳性的516例患者行冠脉造影,根据校正的TIMI帧数(TFC)计数血流分级32例(6.2%)冠状动脉慢血流患者作为慢血流组,同期造影正常的32例患者作为对照组。描述临床特征、冠心病危险因素及实验室检查指标。结果与对照组比较,慢血流组ET-1水平显著增高(P<0.05),而血清NO水平显著降低(P<0.05)。慢血流组与正常对照组TFC计数前降支(49±13)帧、(33±2)帧;回旋支(37±12)帧、(24±3)帧;右冠状动脉分别为(36±12)帧、(21±2)帧(P<0.001)。Logistic回归分析显示吸烟者慢血流显著高于非吸烟者(β=1.114,OR=4.682,P<0.01)。结论冠脉内局部ET-1、NO水平与冠脉血流显著相关,升高ET-1、降低NO可能诱发慢血流。吸烟可能为慢血流的临床危险因素。

Objective To investigate the relation between coronary flow（CSF）and intracoronary plasma endothelin-1 （ET-I） and nitric oxide （NO）concentrations, and clinical characteristics in patients with CSF. Methods Based on the Thrombolysis In Myocardial Infarction frame count （TIMI）, 32（6.2%） consecutive patients who underwent coronary angiography due to typical chest pain or ischemic on tread mill exercise test in the department of cardiology were served as CSF groupand 32 patients with normal coronary angiography served as control group. Baseline characteristics, labparameters, coronary risk factors were described, consequently. Results The CSF group＇s intracoronary plasma ET-1 concentrations were significantly higher than control group and NO concentrations were significantly lower than control group （P〈0.05）. TFC for left anterior descending coronary artery （LAD）,left circumflex coronary artery （LCX） and right coronary artery （RCA） separately in patients with CSF group and control group were （49±13）frames vs（33±2）frames; （37±12） frames vs （24±3）frames ; （36±12） frames vs （21±2） frames, respectively （P〈0.001）. logistic regression analysis suggested that CSF were significantly higher in smokers than in nonsmokers （β=1.114, OR=4.682 ,P〈0.01 ）. Conclusion There is a significant relation between ET-I and NO concentrations and CSF; Increased ET-1 and discreased NO concentrations are probably induced CSF. Smoking is strongly associated with CSF.