冠心病及其高危患者血管功能无创性检测的临床意义

The clinical significance of non-invasive assessing vascular function in patients with coronary heart disease or coronary risk factors

目的 :探讨冠心病和具有冠心病危险因素患者的血管内皮和平滑肌功能无创性检测的临床意义。方法 :采用高分辨超声技术 ,检测 90例健康成人 (正常对照组 )、110例有冠心病危险因素者 (危险因素组 )和 71例冠心病患者 (冠心病组 )在反应性充血时及含服硝酸甘油后的肱动脉内径变化。结果 :危险因素组和冠心病组血流介导的肱动脉舒张 (FMD)均明显低于正常对照组 [(4 .79± 3.93) %和 (2 .4 4± 2 .94 ) %比 (8.76± 4 .33) % ,均P <0 .0 1];冠心病组硝酸甘油引起的肱动脉舒张 (NID)明显低于正常对照组 [(16 .5 8± 6 .2 6 ) %比 (2 3.6 2±8.5 5 ) % ,P <0 .0 1],但危险因素组的NID与正常对照组无统计学意义 [(2 0 .5 0± 7.30 ) %比 (2 3.6 2± 8.5 5 ) % ,P >0 .0 5 ]。多元逐步回归分析显示 :FMD与年龄、肱动脉基线内径和收缩压呈负相关 ,与高密度脂蛋白胆固醇呈正相关 ;而NID与肱动脉基线内径呈负相关 ,与FMD呈正相关。结论 :血管内皮功能失调是动脉粥样硬化临床前的早期表现 。

Objective:To investigate the clinical significance of non-invasive assessing endothelial and smooth muscle function in patients with coronary heart disease or coronary risk factors.Method:By using high resolution ultrasound, the dilatation changes of brachial arteries during reactive hyperemia and after sublingual administration of nitroglycerin (NTG) were measured in 90 healthy adults (normal control group), 110 persons with coronary risk factors (risk factor group) and patients with established coronary heart disease (CHD group).Result:The flow-mediated dilatation (FMD) of brachial arteries in risk factor group and CHD group was much lower compared with that in normal control group[( 4.79± 3.93)% and ( 2.44± 2.94)% vs ( 8.76± 4.33)%,P< 0.01 for all]. The NTG-induced dilatation (NID) of brachial arteries in CHD group was significantly lower than that in normal control group [( 16.58± 6.26)% vs ( 23.62± 8.55)%,P< 0.01], but there was no difference in response to NGT between the patients with risk factors and normal controls [( 20.50± 7.30)% vs ( 23.62± 8.55)%, P> 0.05]. By mutiple stepwise regression analysis, FMD was inversely associated with age, baseline diameters of brachial arteries and systolic blood pressure and positively related to HDL-C; whereas decreased NID was independently related to larger brachial artery size and reduced FMD.Conclusion:The endothelium-dependent vasodilatation dysfunction is an early preclinical marker of atherosclerosis, whereas the smooth muscle dysfunction usually suggests that the patients have had an overt atherosclerosis disease.