不稳定型心绞痛患者血管内皮功能与同型半胱氨酸及颈动脉内膜中膜厚度相关

Endothelial Function Was Correlated with the Plasma Level of Homocysteine and Carotid Intima-Media Thickness in Patients with Unstable Angina Pectoris

目的探讨不稳定型心绞痛(UAP)患者血管反应性充血指数(RHI)与血同型半胱氨酸(Hcy)及颈动脉内膜中膜厚度(IMT)的相关性。方法选取245例接受冠状动脉造影的患者为研究对象,冠状动脉造影阳性者中分为稳定型心绞痛(SAP)组49例和不稳定型心绞痛(UAP)组131例,冠状动脉造影阴性者65例为对照组,利用Endo-PAT2000仪器采用外周动脉张力测定(PAT)技术评价血管内皮功能,计算RHI;通过超声检测患者颈动脉IMT;采用循环酶法测定Hcy水平。结果 RHI在对照组、SAP组和UAP组依次减低(1.78±0.45、1.65±0.33和1.45±0.27),差异均有统计学意义(P<0.05);IMT在对照组、SAP组和UAP组依次增加(分别为0.76±0.24 mm、0.90±0.31 mm、1.05±0.18 mm),差异均有统计学意义(P<0.05);SAP组的Hcy与对照组相比差异无统计学意义(P>0.05),UAP组的Hcy与对照组及SAP组相比差异均有统计学意义(17.61±6.79μmol/L比14.16±4.54μmol/L和14.31±4.53μmol/L,P<0.01);UAP患者RHI与血清Hcy及颈动脉IMT均呈显著负相关(r=-0.494,r=-0.513,P<0.01);通过回归分析得到UAP患者IMT(X1)、收缩压(X2)、BMI(X3)与RHI(Y)成线性回归关系。结论血管内皮功能、IMT、Hcy与冠心病患者病情相关;UAP患者RHI值与血清Hcy及IMT有明显负相关关系。

Aim To investigate the relationship between reactive hyperemia index（ RHI） and blood homocysteine（ Hcy） or carotid intima-media thickness（ IMT） in patients with unstable angina pectoris（ UAP）. Methods A total of 245 consecutive patients taken coronary angiography（ CAG） were enrolled in this study,and then divided,according to CAG,into normal group（ n = 65）,SAP group（ n = 49） and UAP group（ n = 131）. Vascular endothelial function was reviewed and RHI was calculated by using peripheral arterial tension（ PAT） detection with Endo-PAT2000（ Itamar Medical Inc）. IMT were measured with Color Doppler,and serum Hcy level was determined with enzymatic cycling assay. Results The RHI was significantly lower in UAP group than in the SAP group and normal group（ UAP groupSAP groupnormal group,P〈0.05）; IMT was significantly higher in the UAP group than in SAP group or in normal group（ UAP groupSAP groupnormal group,P〈0.05）; Hcy was significantly higher in UAP group than in normal group（ P〈0.05）; In UAP group,RHI was negatively correlated with serum Hcy level and carotid IMT（ r =- 0.494,r =- 0.513,P〈0.01）; Multiple linear regression analysis showed that it was independently correlated between IMT（ X1）,systolic pressure（ X2）,BMI（ X3） and RHI（ Y） in patients with UAP. Conclusion The serum Hcy level and IMT are positively associated with endothelial dysfunction（ ED） in UAP patients,the serum Hcy level,IMT and RHI are correlated with the condition of patients with coronary heart disease.