内皮功能不全与冠心病

内皮细胞通过产生和释放血管反应性调解历子如内皮衍生舒张因子（EDRF）和一氧化氮（NO）,在维持心血管系统稳态中起中心作用。内皮功能不全可能通过下列途径在冠心病尤其是动脉粥样硬化和血栓早期形成和发展阶段的病理生理机制中起关键作用：（1）导致冠状动脉血管张力调节机能受损；（2）加速冠状动脉知管壁重塑过程；（3）促进血小板活化和聚集；（4）促进单核细胞和中性粒细胞活化和粘附。内皮功能不全和许多冠心病危险因素如血脂异常、高血压、吸烟、糖尿病、肥胖、年龄、性别等密切相关，同时与冠心病的许多临床类型如心绞痛、急性心肌梗死（AMI）、急性冠状动脉综合`症心衰甚至心律失学相关联，内皮功能不全还与冠心病的药物治疗、介入性治疗和预后有关。因此测定冠状动脉内皮血管反应性可以为有冠心病危险或已患有冠心病的患者提供可作为诊断、治疗和预后工具的关键信息。本综述总结了内皮功能不全和冠心病之间存在密切关系证据。并尽力揭示内皮功能不全对冠心病的作用及其机制。相信，随着对内皮功能不全发生机制的深入了解，可能产生新的预防和治疗策略，从而降低冠心病的发病率和死亡率。

Endothelium Dysfunction and Coronary Heart Disease

The endothelium plays a central role in maintaining cardiovascular homeostasis via the production and release of vasoactive mediators such as endothelium derived relaxing factor (EDRF) and nitric oxide (NO). Endothelium dysfunction plays an essential role in the pathophysiology of coronary heart disease (CHD) especially with the initial and developmental process of atherosclerosis and thrombosis via the following possible mechanisms: (1) causing defects in coronary artery vasomotion,(2) promoting the process of coronary arterial wall remodeling,(3) facilitating platelet activation and aggregation,(4) accelerating monocyte and neutrophils activation and adherence. Endothelium dysfunction is associated with many risk factor of CHD, such as dyslipidemia, hypertension, smoking, diabetes mellitus, obesity, age, gender and clinical patterns of CHD such as angina pectoris, acute myocardial infarction, acute coronary syndromes, heart failure, and even arrhythmias. Endothelium dysfunction is also associated with the drug treatment, interventional therapy and the prognosis of CHD. So the assessment of coronary endothelial vasoreactivity can provide pivotal information as a diagnostic, therapeutic and prognostic tool in patients at risk for CHD or really having CHD. This review summarizes evidence for the deep association between endothelial dysfunction and CHD. Then tries to unveil the effects of endothelial dysfunction on CHD and its mechanisms. To believe, a better understanding of the mechanisms of endothelial dysfunction may lead to new preventive and therapeutic strategies to reduce morbidity and mortality of CHD.