冠状动脉成形术后冠状静脉脂质过氧化物浓度：与心肌缺血的生化及心电图证据的相关性

Coronary venous lipid peroxide concentrations after coronary angioplasty: correlation with biochemical and electrocardiographic evidence of myocardial ischaemia.

作者信息

Oldroyd K G, Paterson J R, Rumley A G, Eteiba H, Rae A P, Shepherd J, Cobbe S M, Hutton I

机构信息

Department of Medical Cardiology, Royal Infirmary, Glasgow.

出版信息

Br Heart J. 1992 Jul;68(1):43-7. doi: 10.1136/hrt.68.7.43.

DOI:10.1136/hrt.68.7.43

PMID:1515290

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1024968/

Abstract

BACKGROUND

Raised lipid peroxide concentrations in coronary venous plasma have been reported after coronary angioplasty in humans. This may reflect increased free radical activity after myocardial ischaemia and reperfusion. If so, it may be possible to correlate lipid peroxide concentrations with the degree of myocardial ischaemia produced during angioplasty.

METHODS

15 patients (age range 42-70; 12 men) with stable angina pectoris undergoing angioplasty of a proximal left anterior descending coronary artery stenosis were studied. Plasma lipid peroxide and lactate concentrations were measured in sequential blood samples taken from the great cardiac vein before and immediately after one to five serial 60 second balloon inflations. The maximum ST segment shift during each balloon inflation was also measured.

RESULTS

Lipid peroxide concentrations in coronary venous plasma were raised from pre-angioplasty values by more than 2 SDs of the relevant measurement error after 27 out of 46 (59%) balloon inflations. Lactate concentrations were raised after 43 out of 46 (93%) balloon inflations. No significant difference was found between the peak percentage change of either lipid peroxide or lactate concentrations after any of the first three serial inflations. The maximum ST segment shift after each of the first three serial inflations was also similar. Coronary venous lactate concentrations after balloon inflation correlated positively with the maximum ST segment shift, but did not correlate with lipid peroxide concentrations.

CONCLUSIONS

Raised lipid peroxide concentrations in coronary venous plasma can be detected in humans after balloon angioplasty. There is no positive correlation between lipid peroxide concentrations in coronary venous plasma after angioplasty and the degree of preceding myocardial ischaemia as assessed by either ST segment shift or lactate production. These indices showed that one to three serial 60 second balloon inflations each produce a similar degree of myocardial ischaemia. The origin of the raised lipid peroxide concentrations in coronary venous plasma after angioplasty remains unknown.

摘要

背景

据报道，人类冠状动脉成形术后冠状静脉血浆中脂质过氧化物浓度升高。这可能反映了心肌缺血再灌注后自由基活性增加。如果是这样，那么脂质过氧化物浓度可能与血管成形术期间产生的心肌缺血程度相关。

方法

研究了15例（年龄范围42 - 70岁；12例男性）患有稳定型心绞痛且正在接受左前降支近端冠状动脉狭窄血管成形术的患者。在进行一至五次连续60秒球囊扩张之前和之后，立即从大心静脉采集连续血样，测量血浆脂质过氧化物和乳酸浓度。同时测量每次球囊扩张期间的最大ST段移位。

结果

在46次球囊扩张中的27次（59%）后，冠状静脉血浆中的脂质过氧化物浓度比血管成形术前的值升高超过相关测量误差的2个标准差。在46次球囊扩张中的43次（93%）后乳酸浓度升高。在前三次连续扩张中的任何一次后，脂质过氧化物或乳酸浓度的峰值百分比变化之间均未发现显著差异。前三次连续扩张中每次的最大ST段移位也相似。球囊扩张后冠状静脉乳酸浓度与最大ST段移位呈正相关，但与脂质过氧化物浓度无关。

结论

人类球囊血管成形术后可检测到冠状静脉血浆中脂质过氧化物浓度升高。血管成形术后冠状静脉血浆中脂质过氧化物浓度与通过ST段移位或乳酸产生评估的先前心肌缺血程度之间无正相关。这些指标表明，每次一至三次连续60秒的球囊扩张产生的心肌缺血程度相似。血管成形术后冠状静脉血浆中脂质过氧化物浓度升高的原因尚不清楚。