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目的:探讨冠状动脉痉挛患者的血脂水平与血管内皮细胞功能的关系。方法:选择因静息性胸痛住院、且冠状动脉造影无显著狭窄的患者64例,经乙酰胆碱激发试验分为冠状动脉痉挛组(痉挛组,n=46例)和非痉挛组(对照组,n=18例),分别测定并比较两组的血脂谱及血清内皮素(ET-1)、一氧化氮(NO)和血脂水平,痉挛组接受至少6个月的钙拮抗剂、调脂治疗和抗血小板联合治疗,复查ET-1、No及血脂。结果:痉挛组患者的血清ET-1及低密度脂蛋白胆固醇(LDL-C)水平均显著高于对照组(P<0．05),而No和高密度脂蛋白胆固醇(HDL-C)水平均低于对照组但无显著统计学意义(P>0．05)。经过联合治疗6个月后,ET-1、LDL-C及TG水平均显著降低,NO及HDL-C均显著升高(P<0．05);胸痛发作频次由(6±3)次／月减少到(1±2)次／月(P<0．001)。痉挛组ET-1水平与LDL-C呈显著正相关(r=0．71,P<0．01),而与HDL-C呈负相关(r=-0．48,P<0．05)。NO水平与LDL-C呈显著负相关(r=-0．65,P<0．01),而与HDL-C呈显著正相关(r=0．69,P<0．01)。结论:ET-1升高和NO储备降低是冠状动脉痉挛的重要病理生理基础之一,LDL-C和HDL-C是血管内皮功能紊乱的重要相关因素,联合治疗在改善血脂代谢的同时能逆转内皮细胞功能,并缓解临床症状。
Objective: To investigate the relationship between serum lipids and the function of vascular endothelial cells in patients with coronary artery spasm. Methods: Sixty-four patients with hospitalized rest chest pain and no significant stenosis of coronary angiography were divided into coronary spasm group (spastic group, n = 46) and non-spastic group (control group, n = 18 cases). The serum lipid profile, serum endothelin (ET-1), nitric oxide (NO) and blood lipid level were measured and compared. The spasm group received at least 6 months calcium antagonist, lipid-lowering therapy and Antiplatelet therapy, review ET-1, No and blood lipids. Results: The levels of serum ET-1 and LDL-C in patients with spasticity were significantly higher than those in the control group (P <0.05), while No and HDL-C But lower than the control group but no statistically significant (P> 0.05). After 6 months, the levels of ET-1, LDL-C and TG were significantly decreased, and the levels of NO and HDL-C were significantly increased (P <0.05); the frequency of chest pain was decreased from (6 ± 3) Month to (1 ± 2) times / month (P <0.001). The level of ET-1 in spasm group was positively correlated with LDL-C (r = 0.71, P <0.01), but negatively correlated with HDL-C (r = -0.48, . The level of NO was negatively correlated with LDL-C (r = -0.65, P <0.01), but positively correlated with HDL-C (r = 0.69, P <0.01). Conclusions: Elevated ET-1 and decreased NO reserve are important pathophysiological basis of coronary artery spasm. LDL-C and HDL-C are important related factors of vascular endothelial dysfunction. Combination therapy can reverse lipid metabolism Endothelial cells function and relieve clinical symptoms.