非阻塞性冠状动脉微血管病患者血浆内皮素-1和一氧化氮水平的变化及临床意义

Changes and clinical significance of plasma ET-1 and NO levels in patients with non-obstructive coronary microvascular disease

目的 探讨非阻塞性冠状动脉微血管疾病患者外周血浆内皮素-1(ET-1)和一氧化氮(NO)含量的变化及临床意义。方法 选取2019年1月至2021年6月在本院住院的非阻塞性冠状动脉微血管病患者69例为研究对象,以同期健康体检正常者30例为正常对照组,比较两组年龄、性别、高血压、糖尿病、高血脂、肥胖、吸烟、高同型半胱氨酸等指标,分析非阻塞性冠状动脉微血管病的可能的危险因素,采用酶联免疫吸附试验检测两组对象外周血ET-1和NO水平,比较两组间ET-1和NO水平的差异,根据诊断标准将非阻塞性冠状动脉微血管病分为原发性稳定型心绞痛组35例、原发性不稳定型心绞痛组34例,与30例正常对照组做对照,比较三组间ET-1和NO水平的差异。根据患者的危险因素个数分成无危险因素组、1~3个危险因素组、4~6个危险因素组,比较三组间ET-1和NO水平的差异。结果 非阻塞性冠状动脉微血管病组与正常对照组比较,高血压、糖尿病、高血脂、肥胖、吸烟、高同型半胱氨酸血症发生率及女性占比均明显升高,差异具有统计学意义(P<0.05);两组间年龄比较,差异无统计学意义(P>0.05);两组ET-1、NO水平比较,非阻塞性冠状动脉微血管病组ET-1水平显著高于正常对照组[(219.52±10.71)ng/L比(112.91±6.30)ng/L];NO水平显著低于正常对照组[(106.48±8.34)μmol/L比(204.49±9.68)μmol/L]。原发性不稳定型心绞痛组、原发性稳定型心绞痛组、正常对照组ET-1水平比较[(253.72±10.70)ng/L比(187.64±11.18)ng/L比(112.91±6.30)ng/L,P<0.05];三组间NO水平比较[(106.48±8.34)μmol/L比(168.15±9.42)μmol/L比(241.91±10.16)μmol/L,P<0.05]。无危险因素组、1~3个危险因素组、4~6个危险因素组ET-1水平比较[(169.87±5.16)ng/L比(201.94±8.12)ng/L比(279.16±12.25)ng/L,P<0.05],三组间NO水平比较[(257.79±11.66)μmol/L比(188.35±8.42)μmol/L比(146.23±4.89)μmol/L,P<0.05]。结论 女性、高血压、糖尿病、高血脂、肥胖、吸烟、高同型半胱氨酸症可能是非阻塞性冠状动脉微血管病的危险因素,外周血浆ET-1、NO水平高低可间接反应非阻塞性冠状动脉微血管病患者病情,具有一定的临床应用价值。

Objective To investigate the change and clinical significance of endothelin-1(ET-1) and nitric oxide(NO) levels in peripheral blood of patients with non-obstructive coronary microvascular disease. Methods Sixty-nine patients with non-obstructive coronary microvascular disease who were hospitalized in our hospital from January 2019 to June 2021 were selected as the study subjects, and 30 healthy subjects who underwent physical examination during the same period were selected as the control group. Age, sex, hypertension, diabetes,hyperlipidemia, obesity, smoking, high homocysteine and other indicators were compared between the two groups.The possible risk factors of non-obstructive coronary microangiopaemia were analyzed. The levels of ET-1 and NO in peripheral blood of the two groups were detected by Elisa. The differences of the levels of ET-1 and NO between the two groups were compared. According to the diagnostic criteria, the patients with non-obstructivecoronary microangiopaemia were divided into the primary stable angina group(35 cases) and primary unstable angina group(34 cases), 30 healthy subjects were as the control group. The levels of ET-1 and NO were compared among the three groups. According to the number of risk factors, patients were divided into the no risk factor group, 1-3 risk factor group, 4-6 risk factor group, and the differences of ET-1 and NO levels among the three groups were compared. Results Compared with normal control group, the incidence of hypertension, diabetes,hyperlipidemia, obesity, smoking, hyperhomocysteinemia and female proportion were significantly higher in the non-obstructive coronary microangiopaemia group(P<0.05). There was no significant difference in age between the two groups(P>0.05). The level of ET-1 was significantly higher in the non-obstructive coronary microangiopaemia group than in the control group [(219.52±10.71) ng/L vs.(112.91±6.30) ng/L]. The level of NO in the non-obstructive coronary microangiopaemia groupwas significantly lower than that of normal control group[(106.48 ± 8.34) μmol/L vs.(204.49 ± 9.68) μmol/L]. ET-1 levels of the primary unstable angina group, primary stable angina group and normal control group were [(253.72 ± 10.70) ng/L vs.(187.64 ± 11.18) ng/L vs.(112.91 ±6.30) ng/L, P<0.05]. NO levels of the three groups were [(106.48 ± 8.34) μmol/L vs.(168.15 ± 9.42) μmol/L vs.(241.91±10.16) μmol/L, P<0.05]. ET-1 levels of the no risk factor group, 1-3 risk factor group and 4-6 risk factor group [(169.87 ± 5.16) ng/L vs.(201.94 ± 8.12) ng/L vs.(279.16 ± 12.25) ng/L, P<0.05]. NO levels of the three groups were [(257.79±11.66) μmol/L vs.(188.35±8.42) μmol/L vs.(146.23±4.89) μmol/L, P<0.05]. Conclusion Female, hypertension, diabetes, hyperlipidemia, obesity, smoking and hyperhomocysteine may be the risk factors for non-obstructive coronary microangiopaemia. The level of ET-1 and NO in peripheral blood could indirectly reflect the disease of non-obstructive coronary microangiopaemia, which would have certain clinical application value.