Ajtay Zénó, Scalera Fortunato, Cziráki Attila, Horváth Iván, Papp Lajos, Sulyok Endre, Szabo Csaba, Martens-Lobenhoffer Jens, Awiszus Friedemann, Bode-Böger Stefanie M
Heart Institute, Faculty of Medicine, University of Pécs, Ifjúság u. 13., H-7624 Pécs, Hungary.
Int J Mol Med. 2009 May;23(5):651-7. doi: 10.3892/ijmm_00000176.
The concentration of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, is increased in patients with coronary heart disease (CHD). The potential effect of percutaneous coronary intervention (PCI) with stent placement on ADMA plasma level in CHD patients has not yet been investigated. Concentrations of ADMA, L-arginine, symmetric dimethylarginine (SDMA), and L-ornithine were measured in the plasma of 30 CHD patients 24 h before, and 1 h, 5 days, and 30 days following PCI with bare-metal stent or drug-eluting stent placement (stent group) and in the plasma of 20 patients without CHD who underwent angiography alone (control group). A repeated measures ANOVA revealed the significant time by group interaction for ADMA (F=12.8, p<0.0001), SDMA (F=5.5, p=0.013), L-ornithine (F=12.5, p<0.0001), L-aginine (F=4.7, p=0.013) and L-arginine/ADMA ratio (F=7.1, p<0.001). Post-hoc ANOVAs showed that this interaction was due to the fact that control patients without stent placement responded to the coronary angiography with a significant increase in ADMA (F=4.4, p=0.009), SDMA (F=4.7, p=0.007) and L-ornithine (F=28.3, p<0.0001) levels, whereas the stent implantation independent of the stent type used significantly reduced the cardiovascular risk factor ADMA (F=10.8, p<0.0001). Thus, the current study demonstrates that in patients with CHD, PCI stent placement markedly decreases the plasma level of cardiovascular risk factor ADMA. Coronary angiography alone results in an increase of ADMA. We conclude that the stent effect on ADMA level cannot be explained by unspecific effects of the coronary angiography and is independent of the stent type used.
一氧化氮合酶的内源性抑制剂不对称二甲基精氨酸（ADMA）在冠心病（CHD）患者体内的浓度会升高。经皮冠状动脉介入治疗（PCI）并植入支架对CHD患者血浆中ADMA水平的潜在影响尚未得到研究。在30例接受裸金属支架或药物洗脱支架植入PCI的CHD患者（支架组）血浆中，以及20例仅接受血管造影的非CHD患者（对照组）血浆中，分别于PCI前24小时、PCI后1小时、5天和30天测量ADMA、L-精氨酸、对称二甲基精氨酸（SDMA）和L-鸟氨酸的浓度。重复测量方差分析显示，ADMA（F=12.8，p<0.0001）、SDMA（F=5.5，p=0.013）、L-鸟氨酸（F=12.5，p<0.0001）、L-精氨酸（F=4.7，p=0.013）和L-精氨酸/ADMA比值（F=7.1，p<0.001）存在显著的组间时间交互作用。事后方差分析表明，这种交互作用是由于未植入支架的对照患者在接受冠状动脉造影后，ADMA（F=4.4，p=0.009）、SDMA（F=4.7，p=0.007）和L-鸟氨酸（F=28.3，p<0.0001）水平显著升高，而无论使用何种类型的支架，支架植入均显著降低了心血管危险因素ADMA（F=10.8，p<0.0001）。因此，本研究表明，在CHD患者中，PCI支架植入显著降低了心血管危险因素ADMA的血浆水平。单纯冠状动脉造影会导致ADMA升高。我们得出结论，支架对ADMA水平的影响不能用冠状动脉造影的非特异性效应来解释，且与所使用的支架类型无关。
