腺苷负荷实时三维超声心动图及冠状动脉造影用于稳定型心绞痛患者病情评估的价值

Evaluation value of real-time three-dimensional adenosine stress echocardiography and coronary angiography for patients with stable angina pectoris

目的:研究腺苷负荷实时三维超声心动图及冠状动脉造影用于稳定型心绞痛患者病情评估的价值。方法:选择在我院确诊为稳定型心绞痛的45例患者作为研究的稳定型心绞痛组(SAP组),同期在我院体检的50例健康者作为对照组。行腺苷负荷实时三维超声心动图并测定冠状动脉血流储备(CFR),采集血清并测定脂质代谢指标、炎症反应指标,采集外周血单个核细胞并测定炎症调控分子的表达量。结果:SAP组CFR显著低于对照组且病变冠脉支数越多、SAP组CFR越低;SAP组血清中Lp(a)、LDL-C、ApoB、MIF-1α、ICAM-1、VCAM-1、CD40、CD40L的含量以及外周血单个核细胞表面TLR4、NF-kB的荧光强度显著高于对照组且与CFR水平呈负相关,血清中HDL-C、ApoA1的含量以及外周血单个核细胞表面TIPE2、BACH2的荧光强度显著低于对照组且与CFR水平呈正相关。结论:稳定型心绞痛患者腺苷负荷实时三维超声心动图测定的CFR显著降低且与脂质代谢状态、炎症反应程度具有相关性。

Objective： To study the evaluation value of real-time three-dimensional adenosine stress echocardiography and coronary angiography for patients with stable angina pectoris. Methods： A total of 45 patients diagnosed with stable angina pectoris in our hospital were selected as the stable angina pectoris group （SAP group） of the study and 50 healthy subjects re- ceiving physical examination in our hospital during the same period were selected as control group. Real-time three-dimensional adenosine stress echocardiography was performed to measure coronary flow reserve （CFR）, serum was collected to determine lipid metabolism indexes and inflammation indexes, and peripheral blood mononuclear cells were collected to determine the ex- pression levels of inflammatory regulatory molecules. Results： CFR of SAP group was significantly lower than that of control group and the more the number of coronary lesions, the lower the CFR of SAP group; serum Lp（a）, LDL-C, ApoB, MIF-la, ICAM-1, VCAM-1, CD40 and CD40L content as well as the fluorescence intensity of peripheral blood mononuclear cell surface TLR4 and NF-kB of SAP group were significantly higher than those of control group and negatively correlated with CFR level while serum HDL-C and ApoA1 content as well as the fluorescence intensity of peripheral blood mononuclear cell surfaceTIPE2 and BACH2 were significantly lower than those of control group and positively correlated with CFR level. Conclusion： CFR measured by real-time three-dimensional adenosine stress echocardiography significantly reduces in patients with stable an- gina peetoris and is correlated with lipid metabolism state and the degree of inflammation.