心绞痛患者心肌组织微循环灌注与冠状动脉内皮损伤的相关性及临床意义
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Correlation between myocardial perfusion and coronary endothelial injury in angina patients and its clinical significance
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    摘要:

    目的探讨冠状动脉内皮损伤与心肌组织微循环灌注状况的相关性及其临床意义。方法 30例心绞痛患者均经冠状动脉造影证实有明显冠状动脉狭窄,18例对照组患者经临床检查和选择性冠状动脉造影排除冠心病。在介入手术中采集冠状窦血液标本,测定一氧化氮(NO)、内皮素(ET)含量和循环内皮细胞(CEC)数量,以此反映冠状动脉内皮损伤情况。冠状动脉造影后超声声学造影剂由冠状动脉直接注入,完成超声心肌声学造影。采用视觉评分法对心肌灌注进行定性分析,并由心肌灌注时间-强度曲线得到以下参数进行定量分析:造影剂峰值密度、达峰时间及曲线下面积,分别反映心肌血容量、灌注速度及心肌血流量。结果心绞痛患者尤其是不稳定型心绞痛患者冠状窦血中NO浓度明显降低,ET浓度和CEC数量均明显增高(P<0.01,或P<0.05),NO浓度与心肌组织微循环灌注水平呈显著正相关,ET浓度和CEC数量与之呈显著负相关。结论冠状动脉内皮损伤与心肌组织微循环灌注水平密切相关,心肌组织微循环灌注水平的高低结合实验室检查冠状动脉内皮损伤程度,有助于更确切地评估冠脉病变的程度和判断冠心病患者的预后。

    Abstract:

    ObjectiveTo investigate the correlation between myocardial perfusion and coronary endothelial injury in angina patients. MethodsCoronary stenosis was identified in 30 patients with angina pectoris. Coronary heart disease was excluded in 18 control patients. Blood samples were collected during coronary angiography. The concentrations of nitric oxide (NO),endothelin (ET) and the number of circulating endothelial cells (CEC) in coronary sinus blood were measured to mirror the coronary endothelial injury and dysfunction. Myocardial contrast echocardiography (MCE) was then performed. The images were estimated visually with score on the segmental myocardial perfusion situation. The contrast peak intensity,time to peak intensity (TP) and area under the curve (AUC) of MCE were then analyzed quantitatively by time-intensity curve obtained by equipment attached software. ResultsIn angina patients,especially in unstable angina patients,NO concentration in coronary sinus blood was lower,while ET concentration and CEC number were markedly higher than those in control group(P<0.05). The contrast peak intensity,TP,AUC of MCE showed markedly difference between unstable angina and stable angina patients. ET and CEC had negative correlation with MCE,and NO showed positive correlation with MCE. ConclusionMCE is closely associated with coronary endothelial injury. The combinaton of the two may describe the lesion of coronary artery and evaluate the prognosis of patients with coronary heart disease more satisfactorily.

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晋军,王红,黄岚,于世勇,宋耀明,李爱民,林春梅,陶春蓉.心绞痛患者心肌组织微循环灌注与冠状动脉内皮损伤的相关性及临床意义[J].中华老年多器官疾病杂志,2010,9(4):323~325+330

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