血脂谱及内皮依赖性血管舒张在微血管性心绞痛发病机制中的意义。

Significance of the lipid profile and endothelium-dependent vasodilatation in the pathogenesis of microvascular angina.

作者信息

Liu Qi-ming, Zhou Sheng-hua, Qi Shu-shan, Zhao Shui-ping, Minghuib Liu

机构信息

Department of Cardiology, the Second Xiangya Hospital of Central South University, Changsha, Hunan, China.

出版信息

Cardiol J. 2008;15(4):324-8.

PMID:18698540

Abstract

BACKGROUND

To investigate the significance of lipid disorders and endothelial dysfunction in the pathogenesis of microvascular angina.

METHODS

Levels of plasma lipids, lipoproteins and apolipoproteins were assessed in 21 patients with microvascular angina and 24 healthy subjects as controls. Also, the endothelium-dependent vasodilatation function was determined with high-resolution ultrasound in both groups.

RESULTS

Levels of serum total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), apolipoprotein B(100) (ApoB(100)) and lipoprotein(a) [Lp(a)] in microvascular angina group were significantly higher than those in healthy subjects (each p < 0.05). The flow-mediated dilatation (FMD) in brachial arteries in patients with microvascular angina declined significantly as compared with that in control subjects (4.7 +/- 1.9% vs. 12.8 +/- 3.7%, p < 0.001). However, no significant difference was observed in response to nitroglycerin between groups (19.7 +/- 8.1% vs. 21.2 +/- 6.6%; p > 0.05). Linear correlation analysis revealed a significant negative correlation between the FMD of brachial arteries and the serum levels of LDL-C and Lp(a) in the microvascular angina group (r = -0.5125 and -0.4271, respectively, both p < 0.001). Subsequently, all subjects were pooled and divided into two groups (groups A and B) according to the degree of FMD in brachial arteries (A pound 4% and B > 4%). The serum LDL-C level was found to be significantly higher in group A than in group B (4.09 +/- 0.65 mmol/L vs. 2.59 +/- 0.49 mmol/L; p < 0.05).

CONCLUSIONS

Plasma lipid disorders and vascular endothelial dysfunction may play important roles in the development of microvascular angina. The dysfunction of endothelium-dependent vasodilation was mainly associated with anomalies in LDL-C and Lp(a), and myocardial endothelial dysfunction was aggravated by lipid abnormalities in patients with microvascular angina.

摘要

背景

探讨脂质紊乱和内皮功能障碍在微血管性心绞痛发病机制中的意义。

方法

对21例微血管性心绞痛患者和24例健康对照者进行血浆脂质、脂蛋白和载脂蛋白水平评估。同时，两组均采用高分辨率超声测定内皮依赖性血管舒张功能。

结果

微血管性心绞痛组血清总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、载脂蛋白B(100)（ApoB(100)）和脂蛋白(a) [Lp(a)]水平显著高于健康对照组（均P<0.05）。微血管性心绞痛患者肱动脉血流介导的舒张功能（FMD）较对照组显著下降（4.7±1.9%对12.8±3.7%，P<0.001）。然而，两组间硝酸甘油反应差异无统计学意义（19.7±8.1%对21.2±6.6%；P>0.05）。线性相关分析显示，微血管性心绞痛组肱动脉FMD与血清LDL-C和Lp(a)水平呈显著负相关（r分别为-0.5125和-0.4271，均P<0.001）。随后，将所有受试者按肱动脉FMD程度分为两组（A组和B组）（A组≤4%，B组>4%）。发现A组血清LDL-C水平显著高于B组（4.09±0.65 mmol/L对2.59±0.49 mmol/L；P<0.05）。