非阻塞性冠状动脉粥样硬化患者血管内皮功能与左心室舒张功能的关系

Association between endothelial function and left ventricular diastolic function in patients with nonobstructive coronary atherosclerosis

目的 探讨非阻塞性冠状动脉粥样硬化患者血管内皮功能与左心室舒张功能的关系.方法 选取2013年6月至2015年6月宣武医院心脏内科收治的因胸痛疑诊冠心病、经冠状动脉造影检查证实为非阻塞性冠状动脉粥样硬化症(冠状动脉狭窄<50%)的患者119例,其中男性55例,女性64例,年龄31~85岁,平均年龄60岁.专业培训人员采用标准化问卷调查记录患者临床资料,行超声心动图和肱动脉血流介导内皮依赖性血管舒张功能(FMD)检测,分为FMD正常组(FMD>10%)和减低组(FMD≤10%).根据变量类型采用t检验或χ2检验比较两组间基本临床资料、心脏结构、心脏收缩及舒张功能的参数,采用偏相关分析FMD与心脏收缩和舒张功能指标相关性.结果 研究人群中FMD减低比例占73%,两组人群基本临床资料比较差异无统计学意义(P均>0.05).左心室结构指标室间隔厚度、左心室后壁厚度、左心室舒张末内径和左心室质量指数两组间比较差异无统计学意义(P均>0.05).左心室收缩功能指标每搏输出量、心输出量、左心室短轴缩短率及射血分数组间比较差异无统计学意义(P均>0.05).FMD降低组较FMD正常组E/A比值显著减低(1.0±0.3比1.3±0.4,P<0.001)、E/e'比值显著升高(15.3±6.7比12.6±3.6,P=0.006),控制年龄等影响因素,偏相关分析显示FMD与E/A比值存在正相关(r=0.261,P=0.005),FMD与E/e'呈负相关关系(r=-0.203,P=0.033).结论 在非阻塞性冠状动脉粥样硬化人群中,内皮功能与左心室舒张功能密切相关,内皮功能不全患者左心室舒张功能明显减退.

Objective To investigate the association between endothelial function asessed by flow mediate dliatatin(FMD)and lef venticular distoi functin in patiens with non-obstrctive coronary atheroscleros.Methods A total of 119 consecutiv patients(55 males and 64 females and mean age 60 years)with suspete coronary artery disase confrmed non-obstructiv coronary aterorclerois coronary stenosis 50% with coronary angiography were enolld between June 2013 and Jue 2015.Clinca data were recorded,cardiac structure and function were asseses and FMD was mcasured by echocardiogaphy.The patients were dirvided into FMD normal group(FMD>10%)and FMD impaired group(FMD<10%).Unpaired Student's t-lets were used for continuous variables and Chi-square tests were perfomed for categorical variables to evaluate difrences of clinical characteristics and cchocardiographic parameters between the two groups.Correltions between FMD and echocardiographic markers of left ventricular sytolic and diastolic function were aseses using Partal crelations tests.Resuts The proportion of FMD impaiment in the study population was 73%.There were no significant diferences in any of the clinical variables between the two groups(P>0.05).There were also no significant differences in left ventricular structure interventricular septal thickness,left ventricular posterior wall thickness in diastole,left vnticlar ed-distoi dimension and left vntricular mass index and systolic function stroke volume,cardic output,fractional shorening and let ventricular ejction fraction between the two groups(P>0.05).E/A ratio was declined and E/e'ratio was increased significantly in patients with EMD imaired than those in the FMD normal goup(1.0 vs.13±0.4.P<0.001;15.3±6.7 vs.12.6±3.6,p=0.006,rectevl).FMD pivle coreaed with E/A raot(r=0.261, P=0.005) and ngatively coelated with E/e'(r=-0.203,P=0.033)afer adjusting for potential confounders.Conclusion Left venticular diastolic fumction was worse in endothelial funtion impaired patients with n-obstuctive coronary atheroscleros.