Yokoyama I, Ohtake T, Momomura S, Yonekura K, Kobayakawa N, Aoyagi T, Sugiura S, Sasaki Y, Omata M
Second Department of Internal Medicine, University of Tokyo, Japan.
Arterioscler Thromb Vasc Biol. 1998 Feb;18(2):294-9. doi: 10.1161/01.atv.18.2.294.
Reduced myocardial vasodilatation (MVD) in hypercholesterolemics without overt coronary stenosis has been reported. However, the status of MVD in hypertriglyceridemics has not yet been clarified. The aim of this study was to investigate whether MVD is impaired in patients with hypertriglyceridemia without overt coronary stenosis. Twenty-three hypertriglyceridemics (10 normocholesterolemic hypertriglyceridemics [HTGs] and 13 mixed combined hyperlipidemics [MCHLs]) and 13 age-matched controls were studied. All patients were proven to have more than one normal coronary artery, as diagnosed by coronary angiography, and those segments that were perfused by anatomically normal coronary arteries were used in the study. Myocardial blood flow (MBF) during dipyridamole (DP) loading and baseline MBF were measured by using positron emission tomography and [13N]ammonia, after which MVD was calculated. Baseline MBF (mL.min(-1).100 g(-1)) was comparable among HTG (76.0+/-26.1), MCHL (77.0+/-26.1), and controls (80.3+/-38.5). However, MBF during DP loading was significantly lower in MCHL (159+/-52.5) than in control subjects (292+/-166, P<.01), while it was comparable in HTG (202+/-104) and controls. MVD was significantly reduced in both HTG (2.70+/-1.09, P<.05) and MCHL (2.07+/-.70, P<.01) compared with controls (3.73+/-1.14). MVD in MCHLs tended to be reduced compared with that in HTGs, but the difference was statistically insignificant (P=.08). There was a significant relationship between MVD and both plasma triglycerides (r=-.47, P<.01) and plasma total cholesterol (r=-.55, P<.01). When controls and HTGs were combined, the relationship between MVD and plasma total triglycerides became more prominent (r=-.55, P<.05), and the significant relationship between cholesterol level and MVD disappeared. Multivariate regression analysis has revealed that the triglyceride level (F=5.2, P<.05) was independently related to MVD (r=.69, P<.01). In conclusion, MVD was reduced in hypertriglyceridemics in anatomically normal coronary arteries. Hypertriglyceridemia is an independent factor for this abnormality.
已有报道称，在无明显冠状动脉狭窄的高胆固醇血症患者中，心肌血管舒张（MVD）功能降低。然而，高甘油三酯血症患者的MVD状况尚未明确。本研究旨在调查无明显冠状动脉狭窄的高甘油三酯血症患者的MVD是否受损。研究了23例高甘油三酯血症患者（10例正常胆固醇水平的高甘油三酯血症患者[HTGs]和13例混合型高脂血症患者[MCHLs]）以及13例年龄匹配的对照组。所有患者经冠状动脉造影证实有一支以上正常冠状动脉，研究采用解剖学正常冠状动脉灌注的节段。使用正电子发射断层扫描和[13N]氨测量双嘧达莫（DP）负荷期间的心肌血流量（MBF）和基础MBF，然后计算MVD。基础MBF（mL·min-1·100g-1）在HTG组（76.0±26.1）、MCHL组（77.0±26.1）和对照组（80.3±38.5）中相当。然而，DP负荷期间的MBF在MCHL组（159±52.5）显著低于对照组（292±166，P<0.01），而在HTG组（202±104）与对照组相当。与对照组（3.73±1.14）相比，HTG组（2.70±1.09，P<0.05）和MCHL组（2.07±0.70，P<0.01）的MVD均显著降低。MCHL组的MVD与HTG组相比有降低趋势，但差异无统计学意义（P=0.08）。MVD与血浆甘油三酯（r=-0.47，P<0.01）和血浆总胆固醇（r=-0.55，P<0.01）均存在显著相关性。当对照组和HTG组合并时，MVD与血浆总甘油三酯之间的关系变得更加显著（r=-0.55，P<0.05），胆固醇水平与MVD之间的显著关系消失。多变量回归分析显示，甘油三酯水平（F=5.2，P<0.05）与MVD独立相关（r=0.69，P<0.01）。总之，解剖学正常冠状动脉的高甘油三酯血症患者MVD降低。高甘油三酯血症是导致这种异常的独立因素。
