摘要
目的评价冠状动脉粥样硬化性心脏病(冠心病)患者氧化应激状态和血管内皮功能血清相关标志物的变化。方法正常健康对照者200名(正常对照组),男51名,女149名,平均年龄为(53．4±10．6)岁;经冠状动脉造影检查(CAG)诊断为冠心病患者200例(CAG阳性组),男163例,女37例,平均年龄为(60．3±10．4)岁;经CAG排除的非冠心病患者135例(CAG阴性组),男82例,女53例,平均年龄为(57．8±8．2)岁。患者为2004年9月至2006年1月在我院行首次CAG的住院患者,并排除合并脑血管意外等病变者。评估各组人群的糖、脂代谢等情况。采用分光比色法测定各组受试者的血清抗超氧阴离子自由基(O2(?))活力、脂质过氧化物(MDA)、一氧化氮合酶总活力(tNOS)、诱导型一氧化氮合酶(iNOS)活力和一氧化氮(NO)水平,并对这些指标与冠心病发病及冠状动脉病变严重程度的关系进行相关性分析。结果CAG阳性组的血清抗O2(?)活力、tNOS、iNOS、NO水平均明显低于正常对照组(P值均<0．001),血清MDA水平则明显高于正常对照组(P<0．001)。CAG阳性组血清抗O2(?)活力与CAG阴性组相近(P=0．634),但MDA水平仍明显高于CAG阴性组,同时tNOS、iNOS和NO水平均明显低于CAG阴性组(P值均≤0．001)。CAG阴性组血清抗O2(?)活力明显低于正常对照组(P=0．002),MDA水平明显高于正常对照组(P=0．001),两组间tNOS水平相近(P=0．967),但CAG阴性组的iNOS和NO水平明显低于正常对照组(P≤0．001)。CAG阳性组患者血清NO水平等指标与冠状动脉病变严重程度无明显线性相关。高血清一氧化氮合酶(NOS)水平者患冠心病的风险减少(P=0．002),而男性、高龄、糖尿病及血清高MDA水平增加冠心病患病风险(P值均≤0．01)。结论冠心病患者存在血管内皮功能障碍,体内氧化应激水平较高,其血清清除超氧阴离子能力下降。监测冠心病高危人群的血清NOS和MDA水平有助于冠心病风险的评估。
Objective To evaluate the chang of oxidative stress status and endothelial function in patients with coronary atherosclerotic heart disease （CAD）. Methods The serum scavenging activity for superoxide anion radicals （O2^-）, malondialdehyde （MDA） level, nitric oxide synthase （NOS）, inducible nitric oxide synthase （iNOS） activity, and nitric oxide （NO） level were measured by spectrophotometry in 200 healthy individuals （healthy group）, 200 patients with CAD diagnosed by coronary angiography （CAD group） and 135 patients with normal coronary angiographic features （CAG-negative group）. Glucose metabolism status and plasma lipid profile and relationships of coronary heart disease with these parameters were all analyzed. Results The average serum scavenging activity for OO2^- , NOS, iNOS activity, and NO level in CAD group were much lower than those in the healthy group （P 〈 0. 001 ） while MDA level was higher than that in the healthy group （P 〈0. 001 ）. No obvious difference in serum scavenging activity for O2^- was observed between CAD-group and CAG-negative group （P = 0. 634） while MDA level in CAD group was higher than that in CAG-negative group （P 〈0. 001） and NOS and iNOS activities were lower than those in CAG-negative group. Comparing with the healthy group, CAG negative group had a lower average serum scavenging activity for O2＇ （P = 0. 002）, a higher MDA level （P = 0. 001）, similar NOS activity （P = 0. 967）, decreased iNOS activity （P = 0. 001 ）, and a lower NO level （P 〈 0. 001 ）. No linear correlation between blood NO level and the severity of coronary impairment was observed in CHD patients. Logistic regression analysis showed high NOS level as a protective factor （P = 0. 002） while male, elder, diabetes and high MDA level were risk factors for CHD. Conclusions Endothelial dysfunction, increased oxidative stress, decreased serum scavenging activity for O2^- can be observed in CAD patients. Blood NOS and MDA levels monitorin
出处
《上海医学》
CAS
CSCD
北大核心
2006年第10期687-691,共5页
Shanghai Medical Journal
基金
上海市科委重大项目(04dz19501-1)
