摘要
目的：研究心血管危险因素控制能否达标对急性冠状动脉综合征(ACS)患者心脑血管事件的发生及血管内皮功能的影响,并探讨其机制。方法：对冠状动脉直径狭窄大于50%的109例 ACS 患者给予随访治疗,按能否坚持达标分为达标组50例及未达标组59例,比较两组血脂、血压、内皮依赖性舒张功能(FMD)、一氧化氮、内皮素、总一氧化氮合酶、死亡、急性心肌梗死发生率、不稳定性心绞痛住院发生率等情况。结果：9个月时未达标组因心原性猝死1例。达标组与未达标组在12个月：因不稳定性心绞痛住院发生率、急性心肌梗死发生率、收缩压、舒张压、低密度脂蛋白胆固醇及血糖,均有显著性差异。两组治疗随访6个月及12个月与治疗前比较：FMD、一氧化氮升高,均有显著性差异(P＜0.05～0.001)。治疗随访6个月及12个月时达标组与未达标组相比,FMD、一氧化氮、一氧化氮/内皮素值均升高,均有显著性差异(P＜0.05～0.001)；治疗随访12个月时诱导型一氧化氮合酶(iNOS)达标组与未达标组比较升高,有极显著性差异(P＜0.001)。FMD 与低密度脂蛋白胆固醇呈负相关,直线回归方程为：B=15.2668-1.8065A。FMD 与 iNOS 呈正相关,直线回归方程为：B=8.1662+0.0889A。结论：严格控制冠心病的危险因素达到规定的标准,可明显减少12个月内急性心肌梗死发生率和因不稳定性心绞痛住院的发生率。改善患者血管内皮功能,与低密度脂蛋白胆固醇水平降低和一氧化氮合酶、一氧化氮/内皮素值升高有关。
Objective： To investigate the influence of effectively controlling coronary risk factors on the prognosis and endothelial function in acute coronary syndrome（ACS） patients.
Methods ： One hundred and twenty ACS patients were required to give up smoking, lower high blood pressure, control diabetes mellitus, regulate hyperglycemias and take regular exercise. Twelve months later, these patients were divided into two groups. The first group reached the standard and the second group did not. The blood lipid level, Flow-mediate dilation, nitrous oxide （ NO）, endothelin （ ET）, nitricoxide synthase, unstable angina pectoris （UAP） and acute myocardial infarction （ AMI ） were compared between two groups.
Results ： No significant association between the two groups before the trial. The incidence of unstable angina pectoris and acute myocardial infarction was higher in the second group （P 〈 0.05）. Six and 12 months after the trial, the levels of Flow-mediate dilation,nitrous oxide,NO/ET and iNOS were increased and ET was decreased in the first group compared with the second group. Conclusion： Strictly controlling coronary risk factors can greatly reduce the incidence of unstable angina pectoris and acute myocardial infarction and significantly improve Flow-mediate dilation. The mechanism may be associate with the increased NOS and decreased low-density lipoprotein cholesterol level.
出处
《中国循环杂志》
CSCD
北大核心
2006年第1期15-18,共4页
Chinese Circulation Journal
基金
河北省科技厅项目
项目号022761124
关键词
冠状动脉疾病
危险因素
内皮功能
血管舒张
Coronary artery disease
Risk factors
Endothelial function
Vasodilation
