高血压病患者冠状动脉病变程度与血管相关因子关系的研究

目的探讨脂联素、基质金属蛋白酶9（MMP-9）、血管紧张素Ⅱ（AngⅡ）及内皮素（ET）-1与老年高血压病患者冠状动脉病变的关系。方法选择拟诊为冠状动脉粥样硬化性心脏病（冠心病）行冠状动脉造影检查的老年患者173例。分对照组（30例），造影正常组（40例），冠状动脉粥样硬化组（40例），冠心病组（63例），采用酶联免疫吸附法测MMP-9浓度，采用放射免疫法测ET-1、AngⅡ、脂联素水平。采用Gensini积分方法对冠状动脉病变程度进行定量评价。结果高血压冠状动脉各亚组血浆中脂联素水平显著低于对照组（P〈0．01），且脂联素随着重构增高逐渐降低（P〈0．05）；而MMP-9、AngⅡ、ET-1水平造影正常组MMP-9、AngⅡ、ET-1分别为（274．4±70．1）μg／L，（59．2±15．4）μg／L，（5．0±1．0）μg／L，冠状动脉粥样硬化组分别为（478．5±79．3）μg／L、（69．3±18．2）μg／L、（7．3±2．4）μg／L，冠心病组分别为（615．8±112．8）μg／L、（95．9±26．1）μg／L、（9．0±1．0）μg／L]显著高于对照组MMP-9、AngⅡ、ET-1分别为（137．2±35．6）μg／L、（45．8±13．2）μg／L、（3．3±1．0）μg／L]（P〈0．01），且随着重构增高逐渐增高（P〈0．05）。冠状动脉病变随着Gensini积分增高，血浆MMP-9、AngⅡ、ET-1水平逐渐增高（P〈0．05），而脂联素水平逐渐下降（P〈0．05）。血浆脂联素水平与Gensini积分呈显著负相关（r=-0．714，P〈0．01），血浆MMP-9、AngⅡ、ET-1水平与Gensini积分呈正相关（r=0．841，P〈0．01；r=0．760，P〈0．01；r=0．880，P〈0．01）。多元线性回归分析显示，MMP-9、AngⅡ、ET-1是独立于收缩压、胆固醇外的与Gensini积分相关的因素。结论高血压患者血浆MMP-9、AngⅡ、ET-1、脂联素浓度均可作为预测冠状动脉病变的发生、发展及病变严重程度的指标。

The correlation between vascular-associated factors and severity of coronary artery stenosis in patients with hypertension

Objective To investigate the correlation among plasma APN,MMP-9,Ang Ⅱ,ET-1 levels and severity of coronary artery stenosis.Methods The plasma APN,MMP-9,AngⅡ,ET-1 levels were measured.The degree of artery stenosis was confirmed by coronalyangiographies and assessed quantitatively with Gensini score.Results In old patients with hypertension,the plasma APN level was significantly lower than that of control group (P<0.01).The plasma MMP-9,AngⅡ,ET-1 levels were significantly higher than that of control group(P<0.01).Gensini score increased as the APN level decreased(P<0.05)and the MMP-9,AngⅡ,ET-1 levels increased(P<0.05).The plasma levels of MMP-9,AngⅡ,ET-1 was found to be positively correlated with Gensini 8core(r=0.841,P<0.01;r=0.760,P<0.01;r=0.880,P<0.01).The plasma levels of adiponectin was found to be negatively correlated with Gensini score(,=-0.714,P<0.01).Multiple regression analysis showed that MMP-9,AngⅡ,ET-1 levels were independent factors of Gemini score.Conclusions The plasma MMP-9,AngⅡ,ET-1 levels and the plasma adiponeetin level are closely related to the degree of coronary artery and remode1ing in hypertension patients.The research showes that the plasma APN,MMP-9,Ang Ⅱ,ET-1 levels might be involved in the pathophysiologie process of coronary remodeling.