Huang Po-Hsun, Chen Lung-Ching, Leu Hsin-Bang, Ding Philip Yu-An, Chen Jaw-Wen, Wu Tao-Cheng, Lin Shing-Jong
Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd, Taipei, Taiwan.
Chest. 2005 Aug;128(2):810-5. doi: 10.1378/chest.128.2.810.
Coronary artery calcification determined by electron beam CT (EBCT) is strongly associated with total plaque burden but is not related to systemic vascular inflammation.
We sought to test the hypothesis that enhanced coronary artery calcification, a marker of atherosclerosis and plaque burden, was related to endothelial dysfunction in patients with suspected coronary artery disease (CAD).
One hundred twenty-four subjects with suspected CAD were enrolled. Coronary artery calcification was detected by EBCT. A noninvasive method of brachial ultrasound was used to measure endothelium-dependent flow-mediated vasodilation (FMD) and endothelium-independent nitroglycerin-mediated vasodilation (NMD). Serum high-sensitivity C-reactive protein (hsCRP) and monocyte chemoattractant protein-1 (MCP-1) levels were also determined. Of the 124 patients, the calcium scores ranged from 0 to 4,394. All subjects were classified into three groups according to coronary calcium scores: group 1, score 0 (n = 26); group 2, scores 1 to 199 (n = 50); group 3, scores > or = 200 (n = 48). There was an inverse association between the degree of coronary artery calcification and the endothelium-dependent FMD in the three groups (6.9 +/- 0.6% vs 5.3 +/- 0.3% vs 3.7 +/- 0.3%, respectively; p < 0.001) but not the endothelium-independent NMD. Besides, no significant difference in serum levels of hsCRP and MCP-1 were found among the three groups. However, both the serum levels of hsCRP and MCP-1 were correlated significantly with endothelium-dependent FMD (r = - 0.211, p = 0.019; and r = - 0.188, p = 0.037, respectively). By multivariate analysis, enhanced coronary calcification was a strong independent predictor of endothelial dysfunction (p < 0.001).
Enhanced coronary artery calcification strongly predicted endothelial dysfunction in patients with suspected CAD. Also, serum levels of hsCRP and MCP-1 were significantly correlated with endothelial function. These findings suggested that both calcium deposition and inflammation were involved in endothelial dysfunction.
电子束CT（EBCT）测定的冠状动脉钙化与总斑块负荷密切相关，但与全身血管炎症无关。
我们试图验证以下假设：冠状动脉钙化增强作为动脉粥样硬化和斑块负荷的一个标志物，与疑似冠心病（CAD）患者的内皮功能障碍有关。
纳入124例疑似CAD患者。通过EBCT检测冠状动脉钙化。采用肱动脉超声非侵入性方法测量内皮依赖性血流介导的血管舒张功能（FMD）和非内皮依赖性硝酸甘油介导的血管舒张功能（NMD）。同时测定血清高敏C反应蛋白（hsCRP）和单核细胞趋化蛋白-1（MCP-1）水平。124例患者的钙积分范围为0至4394。根据冠状动脉钙积分将所有受试者分为三组：第1组，积分为0（n = 26）；第2组，积分为1至199（n = 50）；第3组，积分≥200（n = 48）。三组中冠状动脉钙化程度与内皮依赖性FMD呈负相关（分别为6.9±0.6%、5.3±0.3%和3.7±0.3%；p < 0.001），但与非内皮依赖性NMD无关。此外，三组间hsCRP和MCP-1血清水平无显著差异。然而，hsCRP和MCP-1血清水平均与内皮依赖性FMD显著相关（r分别为-0.211，p = 0.019；和r = -0.188，p = 0.037）。多因素分析显示，冠状动脉钙化增强是内皮功能障碍的强独立预测因子（p < 0.001）。
冠状动脉钙化增强强烈预测疑似CAD患者的内皮功能障碍。此外，hsCRP和MCP-1血清水平与内皮功能显著相关。这些发现提示钙沉积和炎症均参与了内皮功能障碍。
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