García-Álvarez Ana, Sitges Marta, Heras Magda, Poyatos Silvia, Posada Elisabeth, Pinazo Maria Jesus, Regueiro Ander, Gascon Joaquim, Sanz Ginés
Instituto Clínico del Tórax, Hospital Clínic, IDIBAPS-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universidad de Barcelona, Barcelona, España.
Rev Esp Cardiol. 2011 Oct;64(10):891-6. doi: 10.1016/j.recesp.2011.05.012. Epub 2011 Jul 28.
The number of patients with Chagas disease in Spain has increased significantly. Chronic inflammation and endothelial dysfunction have been considered among the physiopathological mechanisms of Chagas heart disease. However, there have been conflicting data from clinical studies. Our purpose was to assess endothelial function and systemic levels of nitric oxide and high-sensitivity C-reactive protein in patients with the indeterminate form and with chronic Chagas cardiomyopathy living in a nonendemic area.
Flow-mediated endothelium-dependent vasodilatation and nitroglycerin-mediated vasodilatation were assessed with high-resolution ultrasound of the brachial artery in 98 subjects (32 with the indeterminate form, 22 with chronic Chagas cardiomyopathy and 44 controls). Nitric oxide and high-sensitivity C-reactive protein levels were measured in peripheral venous blood.
Mean age was 37.6 ± 10.2 years and 60% were female. Nitroglycerin-mediated vasodilatation was significantly reduced in chronic Chagas cardiomyopathy compared to controls (median 16.8% vs 22.5%; P=.03). No significant differences were observed in flow-mediated vasodilatation and nitric oxide levels, although a trend towards lower flow-mediated vasodilatation after correction by baseline brachial artery diameter was observed in chronic Chagas cardiomyopathy. Levels of C-reactive protein were significantly higher in patients with the indeterminate form and with Chagas cardiomyopathy compared with controls (P<.05).
Reduced nitroglycerin-mediated vasodilatation suggesting dysfunction of vascular smooth muscle cells was found in patients with chronic Chagas cardiomyopathy living in a nonendemic area. Higher C-reactive protein levels were observed in the indeterminate form and early stages of chronic Chagas cardiomyopathy, which could be related to the inflammatory response to the infection or early cardiovascular involvement.
西班牙恰加斯病患者数量显著增加。慢性炎症和内皮功能障碍被认为是恰加斯心脏病的病理生理机制之一。然而，临床研究的数据存在矛盾。我们的目的是评估生活在非流行地区的无症状型和慢性恰加斯心肌病患者的内皮功能、一氧化氮和高敏C反应蛋白的全身水平。
采用高分辨率肱动脉超声评估98名受试者（32名无症状型、22名慢性恰加斯心肌病患者和44名对照者）的血流介导的内皮依赖性血管舒张和硝酸甘油介导的血管舒张。检测外周静脉血中一氧化氮和高敏C反应蛋白水平。
平均年龄为37.6±10.2岁，60%为女性。与对照组相比，慢性恰加斯心肌病患者硝酸甘油介导的血管舒张显著降低（中位数16.8%对22.5%；P=0.03）。血流介导的血管舒张和一氧化氮水平未观察到显著差异，尽管在慢性恰加斯心肌病患者中，经基线肱动脉直径校正后，血流介导的血管舒张有降低趋势。无症状型和恰加斯心肌病患者的C反应蛋白水平显著高于对照组（P<0.05）。
在生活于非流行地区的慢性恰加斯心肌病患者中，发现硝酸甘油介导的血管舒张降低，提示血管平滑肌细胞功能障碍。在无症状型和慢性恰加斯心肌病早期观察到较高的C反应蛋白水平，这可能与感染的炎症反应或早期心血管受累有关。
