早发心肌梗死患者健康子代血管结构和功能的无创检测

Detection of arterial structural and functional changes in healthy offspring of patients with premature myocardial infarction

目的 探讨早发心肌梗死家族史对健康子代血管内皮依赖性舒张功能和颈动脉内中膜厚度的影响。方法 采用高分辨血管外超声技术 ,检测了 30例有早发心肌梗死家族史的健康子代和31例无心血管病家族史对照者的肱动脉在静息状态下、反应性充血及含服硝酸甘油后的内径变化以及颈动脉内中膜厚度。结果 发现有心肌梗死家族史组肱动脉血流介导性舒张功能 (FMD)较对照组明显减弱 (7 8%± 5 3%比 15 1%± 3 5 %,P <0 0 0 1) ,同时颈动脉内中膜厚度 (IMTc)较对照组明显增厚 [(0 5 3± 0 0 6 )mm比 (0 4 9± 0 0 5 )mm ,P <0 0 1) ],二组合并后直线相关分析发现FMD和IMTc呈负相关 (r= 0 5 45 ,P <0 0 1) ;多因素线性回归分析发现早发心肌梗死家族史是影响FMD和IMTc独立的危险因素 (β= 6 0 76 ,P <0 0 0 1;β =0 0 81,P <0 0 1)。 结论 早发心肌梗死患者健康子代存在血管早期的结构和功能的异常。

Objective To investigate whether there was change in the endothelium-dependent vasodilatation and carotid intima-media thickness in offspring of patients with premature coronary heart disease. Methods With high-resolution ultrasound, we measured the diameter of the brachial arteries at rest, during reactive hyperemia, after sublingual glyceryl trinitrate , and carotid intima-media thickness in 61 subjects, consisting of 31 controls with no history of cardiovascular disease and 30 subjects with family history of premature myocardial infaction(MI). Results The subjects with family history of MI had obvious abnormal flow-mediated vasodilatation(FMD)(7.8%±5.3% vs.15.1%±3.5%, P<0.001) and IMTc (0.53±0.06 mm vs.0.49±0.05 mm,P<0.01) compare with the controls. FMD was inversely correlated with IMTc in 61 subjects(r=-0.545, P<0.01). IMTc and a parental history of premature MI were significantly and independently correlated with FMD(β=-6.076,P<0.001; β= 0.081,P<0.01) by linear-regression analysis. Conclusion Arterial structural and functional changes are present in the healthy offsprings of patient with premature MI.