Kang Seok-Min, Chung Namsik, Kim Ji-Young, Koo Bon-Kwon, Choi Donghoon, Jang Yangsoo, Cho Seung-Yun
Cardiology Division, Yonsei Cardiovascular Center, Yonsei University College of Medicine, 134, Shinchon-Dong, Seodaemun-Gu, Seoul 120-752, Korea.
Echocardiography. 2002 Nov;19(8):661-7. doi: 10.1046/j.1540-8175.2002.00661.x.
Endothelial dysfunction of the coronary artery is closely related to elevated levels of systemic inflammatory markers and cardiovascular events in patients with coronary artery disease (CAD). We hypothesized that patients with CAD may have a higher risk of endothelial dysfunction of the peripheral artery than patients without evidence of CAD, and that endothelial dysfunction of the peripheral artery also may be related to elevated levels of inflammatory markers. Using high resolution ultrasound, we assessed the brachial vasodilator response to reactive hyperemia (endothelium-dependent) and sublingual nitroglycerin (endothelium-independent). As inflammatory markers, serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) levels, and lipid profiles were measured in patients with CAD (n = 30, 16 male and 14 female) and normal subjects without evidence of CAD (n = 45, 23 male and 22 female). Patients with CAD (Group II) showed a significantly reduced endothelium-dependent vasodilation as compared with normal subjects (Group I) (4.4 +/- 3.6 vs 7.4 +/- 6.1%, P < 0.05). However, endothelium-independent vasodilation was not significantly different between the two groups (7.7 +/- 7.1 vs 9.7 +/- 8.0%, P > 0.05). In Group II, CRP level was inversely related to endothelium-dependent vasodilation (r = -0.398, P = 0.029). In contrast, ESR level was not significantly associated to endothelium-dependent vasodilation (r = -0.113, P = 0.552). On multivariate analysis, CRP and low density lipoprotein cholesterol levels were significant independent predictors of a blunted endothelium-dependent vasodilation in Group II. Our study showed that elevated CRP level was associated with blunted endothelium-dependent vasodilation of the brachial artery in patients with CAD. Thus, identification of elevated CRP levels combined with demonstration of endothelial dysfunction of the brachial artery may have a possible clinical application for the detection of high risk CAD patients.
冠状动脉内皮功能障碍与冠状动脉疾病（CAD）患者全身炎症标志物水平升高及心血管事件密切相关。我们推测，CAD患者外周动脉内皮功能障碍的风险可能高于无CAD证据的患者，且外周动脉内皮功能障碍也可能与炎症标志物水平升高有关。我们使用高分辨率超声评估了肱动脉对反应性充血（内皮依赖性）和舌下硝酸甘油（非内皮依赖性）的血管舒张反应。作为炎症标志物，我们测量了CAD患者（n = 30，男性16例，女性14例）和无CAD证据的正常受试者（n = 45，男性23例，女性22例）的血清C反应蛋白（CRP）、红细胞沉降率（ESR）水平及血脂谱。与正常受试者（I组）相比，CAD患者（II组）的内皮依赖性血管舒张明显降低（4.4±3.6 vs 7.4±6.1%，P < 0.05）。然而，两组间非内皮依赖性血管舒张无显著差异（7.7±7.1 vs 9.7±8.0%，P > 0.05）。在II组中，CRP水平与内皮依赖性血管舒张呈负相关（r = -0.398，P = 0.029）。相比之下，ESR水平与内皮依赖性血管舒张无显著相关性（r = -0.113，P = 0.552）。多因素分析显示，CRP和低密度脂蛋白胆固醇水平是II组内皮依赖性血管舒张减弱的显著独立预测因素。我们的研究表明，CAD患者CRP水平升高与肱动脉内皮依赖性血管舒张减弱有关。因此，识别CRP水平升高并结合肱动脉内皮功能障碍的表现可能对检测高危CAD患者具有临床应用价值。
