Ashikaga Takashi, Nishizaki Mitsuhiro, Fujii Hiroyuki, Ihara Kensuke, Niki Saori, Murai Tadashi, Maeda Shingo, Yamawake Noriyoshi, Kishi Yukio, Isobe Mitsuaki
Department of Cardiology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuurahigashi, Kanazawa-ku, Yokohama City, Kanagawa 236-0037, Japan.
J Cardiovasc Pharmacol Ther. 2008 Mar;13(1):58-63. doi: 10.1177/1074248407313397.
Endothelial dysfunction occurs in hyperinsulinemia (HI). Coronary microcirculation responses to vasoactive agents are examined in 57 patients with angiographically normal coronary arteries. Patients were divided into 2 groups, 37 with normoinsulinemia (NI) and 20 with HI based on results of a 75-g oral glucose tolerance test. Epicardial artery vasoactivity in response to acetylcholine chloride is measured to assess endothelial function. Coronary microcirculation function is evaluated by intracoronary administration of 50 microg of adenosine triphosphate, 1 mg of isosorbide dinitrate, and 0.05 mg/kg of atrial natriuretic peptide. Epicardial artery vasoconstriction in response to 100 microg of acetylcholine is mildly reduced in HI (P = .04). Coronary flow reserve in response to adenosine triphosphate in NI is similar to that in HI. In NI, the resting mean (SD) peak velocity in response to isosorbide dinitrate (40.7 [10.9] cm/s) vs atrial natriuretic peptide (39.6 [10.9] cm/s) is similar. In contrast, the resting mean (SD) peak velocity in response to atrial natriuretic peptide (31.3 [9.3] cm/s) vs isosorbide dinitrate (43.5 [10.0] cm/s) in HI is statistically significantly blunted (P < .001). Atrial natriuretic peptide may have a pathologic effect on coronary microcirculation even in mild endothelial dysfunction among patients with HI.
内皮功能障碍发生于高胰岛素血症（HI）。对57例冠状动脉造影正常的患者进行了冠状动脉微循环对血管活性药物反应的研究。根据75克口服葡萄糖耐量试验结果，将患者分为两组，37例为正常胰岛素血症（NI）患者，20例为HI患者。测量乙酰胆碱刺激下的冠状动脉血管活性以评估内皮功能。通过冠状动脉内注射50微克三磷酸腺苷、1毫克硝酸异山梨酯和0.05毫克/千克心房利钠肽来评估冠状动脉微循环功能。HI患者中，对100微克乙酰胆碱的冠状动脉血管收缩反应轻度减弱（P = 0.04）。NI组和HI组中三磷酸腺苷刺激下的冠状动脉血流储备相似。在NI组中，硝酸异山梨酯刺激下的静息平均（标准差）峰值速度（40.7 [10.9]厘米/秒）与心房利钠肽刺激下的相似（39.6 [10.9]厘米/秒）。相比之下，HI组中心房利钠肽刺激下的静息平均（标准差）峰值速度（31.3 [9.3]厘米/秒）与硝酸异山梨酯刺激下的（43.5 [10.0]厘米/秒）相比，在统计学上显著降低（P < 0.001）。即使在HI患者轻度内皮功能障碍的情况下，心房利钠肽也可能对冠状动脉微循环产生病理影响。
