杂合子家族性高胆固醇血症年轻患者的主动脉僵硬度

Aortic stiffness in young patients with heterozygous familial hypercholesterolemia.

作者信息

Pitsavos C, Toutouzas K, Dernellis J, Skoumas J, Skoumbourdis E, Stefanadis C, Toutouzas P

机构信息

Cardiology Department, Hippokration Hospital, University of Athens, Greece.

出版信息

Am Heart J. 1998 Apr;135(4):604-8. doi: 10.1016/s0002-8703(98)70274-1.

DOI:10.1016/s0002-8703(98)70274-1

PMID:9539474

Abstract

BACKGROUND

Dyslipidemia is a primary risk factor for the development of atherosclerosis. Aortic distensibility is an important determinant of left ventricular function and coronary blood flow whose possible alterations in patients with dyslipidemia have not been fully investigated.

METHODS

To assess the effect of dyslipidemia on the elastic properties of the aorta, we studied 60 patients (mean age 37+/-11 years) with heterozygous familial hypercholesterolemia and no manifest arterial disease and compared them with 20 of their normolipidemic siblings (mean age 34+/-10 years). Two indexes of the aortic elastic properties were measured: aortic distensibility was calculated by use of the formula: 2 x (AoS-AoD)/PP x AoD, and aortic stiffness index was calculated by use of the formula: In (SBP/DBP)/(AoS-AoD)/AoD, where AoS and AoD are aortic root end-systolic and end-diastolic diameters, respectively, SBP and DBP are systolic and diastolic arterial pressure, respectively, and PP is pulse pressure. Internal aortic root diameters were measured at 3 cm above the aortic valve by use of two-dimensional guided M-mode transthoracic echocardiography, and arterial pressure was measured simultaneously at the brachial artery by sphygmomanometry.

RESULTS

The mean aortic systolic and diastolic diameter index did not differ significantly between the two groups. In contrast, aortic distensibility was found to be significantly reduced in subjects with isolated familial hypercholesterolemia compared with that in the control group (2.15+/-1.72 cm2.dynes(-1).10(-6) vs 3.18+/-1.58 cm2.dynes(-1).10(-6), p < 0.02). In addition, the mean aortic stiffness index was double in patients with familial hypercholesterolemia compared with that in normolipidemic subjects.

CONCLUSIONS

Severe dyslipidemia does not overtly influence aortic dimensions but leads to impairment of aortic elastic properties before the occurrence of clinical manifestations of atherosclerotic disease.

摘要

背景

血脂异常是动脉粥样硬化发生的主要危险因素。主动脉可扩张性是左心室功能和冠状动脉血流的重要决定因素，血脂异常患者中其可能的改变尚未得到充分研究。

方法

为评估血脂异常对主动脉弹性特性的影响，我们研究了60例杂合子家族性高胆固醇血症且无明显动脉疾病的患者（平均年龄37±11岁），并将他们与其20名血脂正常的兄弟姐妹（平均年龄34±10岁）进行比较。测量了两个主动脉弹性特性指标：主动脉可扩张性通过公式计算：2×(主动脉收缩末期内径 - 主动脉舒张末期内径)/脉压×主动脉舒张末期内径，主动脉僵硬度指数通过公式计算：ln(收缩压/舒张压)/(主动脉收缩末期内径 - 主动脉舒张末期内径)/主动脉舒张末期内径，其中主动脉收缩末期内径和主动脉舒张末期内径分别为主动脉根部收缩末期和舒张末期直径，收缩压和舒张压分别为动脉收缩压和舒张压，脉压为脉压。使用二维引导M型经胸超声心动图在主动脉瓣上方3 cm处测量主动脉根部内径，同时使用血压计在肱动脉处测量动脉压。

结果

两组间主动脉收缩期和舒张期平均直径指数无显著差异。相比之下，发现单纯家族性高胆固醇血症患者的主动脉可扩张性与对照组相比显著降低（2.15±1.72 cm²·dyn⁻¹·10⁻⁶ 对 3.18±1.58 cm²·dyn⁻¹·10⁻⁶，p < 0.02）。此外，家族性高胆固醇血症患者的平均主动脉僵硬度指数是血脂正常受试者的两倍。