Montalescot G, Viossat I, Chabrier P E, Sotirov I, Détienne J P, Drobinski G, Frank R, Grosgogeat Y, Thomas D
Department of Cardiology, Centre Hospitalier Universitaire Pitié-Salpétrière, Paris, France.
J Am Coll Cardiol. 1994 Nov 1;24(5):1236-41. doi: 10.1016/0735-1097(94)90104-x.
This study examined the possible association between endothelin and coronary atherosclerosis and evaluated the synthesis and release of endothelin in the presence of various stimuli that occur during cardiac catheterization.
Circulating endothelin has been reported to be increased in diffuse atherosclerosis and acute myocardial infarction. However, the relation between coronary artery disease and endothelin release remains unclear.
We measured the plasma and urinary concentrations of endothelin immunoreactivity in 45 patients and 10 healthy control subjects.
In group IA (n = 9), simultaneous blood sampling in the coronary sinus and femoral artery during coronary angioplasty of the left anterior descending coronary artery demonstrated no immediate changes in plasma immunoreactive endothelin-1 (ir-ET-1) levels. In 11 patients in group IB undergoing coronary angioplasty of a major artery, we did not detect changes in peripheral plasma concentrations of ir-ET-1 within 24 h, but urinary ir-ET-1 levels increased from 9.2 +/- 2.3 to 18.6 +/- 4.9 pg/mg of creatinine a few hours after coronary angioplasty (mean +/- SEM, p < 0.05). This increase in urinary endothelin excretion persisted 24 h later. Group II patients (n = 12) had coronary angiography without coronary angioplasty. Levels of both plasma and urinary ir-ET-1 did not change during the 24-h follow-up period. There was no relation between the severity of coronary atherosclerosis and the plasma or urinary concentrations of ir-ET-1. Systolic aortic pressure correlated with basal urinary excretion of endothelin (r = 0.54, p = 0.03, n = 15). In group III (n = 13), levels of ir-ET-1 in patients undergoing right heart catheterization without angiography did not differ from those in the control group.
The presence or the severity, or both, of coronary atherosclerosis is not associated with a detectable increase in endothelin release. The diagnostic procedures of catheterization do not modify endothelin concentrations in plasma and urine. Vascular stretch or injury, or both, during coronary angioplasty increases urinary ir-ET-1 levels a few hours after the procedure. This increase persists for at least 24 h but is not detectable by brief sampling of peripheral or coronary sinus blood.
本研究检测内皮素与冠状动脉粥样硬化之间可能存在的关联，并评估在心脏导管插入术期间出现的各种刺激因素作用下内皮素的合成与释放情况。
据报道，在弥漫性动脉粥样硬化和急性心肌梗死患者中，循环内皮素水平升高。然而，冠状动脉疾病与内皮素释放之间的关系仍不明确。
我们测定了45例患者和10名健康对照者血浆及尿液中内皮素免疫反应性物质的浓度。
在IA组（n = 9）中，在对左前降支冠状动脉进行冠状动脉成形术期间，同时从冠状窦和股动脉采集血液样本，结果显示血浆免疫反应性内皮素-1（ir-ET-1）水平无即刻变化。在IB组接受主要动脉冠状动脉成形术的11例患者中，我们在24小时内未检测到外周血浆中ir-ET-1浓度的变化，但在冠状动脉成形术后数小时，尿ir-ET-1水平从9.2±2.3 pg/mg肌酐升高至18.6±4.9 pg/mg肌酐（均值±标准误，p < 0.05）。尿内皮素排泄量的这种增加在24小时后仍持续存在。II组患者（n = 12）仅进行了冠状动脉造影而未进行冠状动脉成形术。在24小时的随访期内，血浆和尿ir-ET-1水平均未发生变化。冠状动脉粥样硬化的严重程度与血浆或尿中ir-ET-1浓度之间无关联。收缩期主动脉压与内皮素基础尿排泄量相关（r = 0.54，p = 0.03，n = 15）。在III组（n = 13）中，未进行血管造影仅接受右心导管插入术的患者的ir-ET-1水平与对照组无差异。
冠状动脉粥样硬化的存在与否、严重程度或二者兼而有之，均与可检测到的内皮素释放增加无关。导管插入术的诊断操作不会改变血浆和尿液中的内皮素浓度。冠状动脉成形术期间的血管扩张或损伤，或二者皆有，会使术后数小时尿ir-ET-1水平升高。这种升高至少持续24小时，但通过外周或冠状窦血液的短时间采样无法检测到。
