Kremastinos D T, Iliodromitis E K, Markianos M, Apostolou T S, Kyriakides Z S, Karavolias G K
Cardiac Department, Athens General Hospital, Greece.
Int J Cardiol. 1996 Mar;53(3):227-32. doi: 10.1016/0167-5273(95)02539-1.
We investigated intracoronary cyclic-guanosine monophosphate (c-GMP) levels during percutaneous transluminal coronary angioplasty (PTCA) since experimental studies have shown the endothelial origin of c-GMP production. Intracoronary c-GMP and cyclic adenosine monophosphate (c-AMP) were measured during coronary angioplasty in 24 patients with chronic coronary artery disease. Four coronary blood samples were taken through a catheter from the coronary artery the first sample before coronary angiography and the other three from distal to coronary obstruction, as follows: before the balloon inflation, at the maximum inflation and 5 min after restoration of coronary flow. c-GMP increased from 7.9 +/- 1.0 pmol/ml and 7.5 +/- 0.9 pmol/ml before angiography and balloon inflation to 11.1 +/- 1.3 pmol/ml at the maximum inflation (P < 0.01), with a trend to decrease 5 min after the end of the intervention (9.5 +/- 1.0 pmol/ml, P: NS). Intracoronary c-AMP levels remained almost unchanged. Five venous samples were taken to measure c-AMP before coronary angiography, before PTCA, and 5 min, 2 h and 24 h after PTCA. c-AMP values 2 and 24 h after PTCA (17.8 +/- 1.7 pmol/ml and 17.5 +/- 1.7 pmol/ml, respectively) were lower than the highest value (22.1 +/- 2.1 pmol/ml) found 5 min after PTCA, (P < 0.001). c-GMP increases distal to coronary obstructive lesion during PTCA at the time of balloon inflation, while c-AMP remains unchanged. c-AMP rises in venous circulation only. PTCA stimulates the mechanism of c-GMP release, while systemic c-AMP increase seems to be related to the stress occurring during catheterisation and PTCA.
由于实验研究表明环磷酸鸟苷（c-GMP）的产生源于内皮细胞，因此我们对经皮腔内冠状动脉成形术（PTCA）期间冠状动脉内的c-GMP水平进行了研究。对24例慢性冠状动脉疾病患者在冠状动脉成形术期间测量冠状动脉内的c-GMP和环磷酸腺苷（c-AMP）。通过导管从冠状动脉采集4份冠状动脉血样，第一份样本在冠状动脉造影前采集，另外3份从冠状动脉阻塞远端采集，如下：球囊扩张前、最大扩张时以及冠状动脉血流恢复后5分钟。c-GMP从冠状动脉造影和球囊扩张前的7.9±1.0 pmol/ml和7.5±0.9 pmol/ml增加到最大扩张时的11.1±1.3 pmol/ml（P<0.01），干预结束后5分钟有下降趋势（9.5±1.0 pmol/ml，P：无统计学意义）。冠状动脉内c-AMP水平几乎保持不变。在冠状动脉造影前、PTCA前以及PTCA后5分钟、2小时和24小时采集5份静脉血样以测量c-AMP。PTCA后2小时和24小时的c-AMP值（分别为17.8±1.7 pmol/ml和17.5±1.7 pmol/ml）低于PTCA后5分钟发现的最高值（22.1±2.1 pmol/ml）（P<0.001）。在PTCA期间球囊扩张时，冠状动脉阻塞病变远端的c-GMP增加，而c-AMP保持不变。c-AMP仅在静脉循环中升高。PTCA刺激c-GMP释放机制，而全身c-AMP增加似乎与导管插入术和PTCA期间发生的应激有关。
