停用辛伐他汀对冠心病及冠心病危险因素患者血管内皮功能的影响

目的 观察在冠心病及冠心病危险因素患者中,停用辛伐他汀治疗对血管内皮功能的影响,并探讨相应作用机制。方法 入选33例血清胆固醇（Tc）水平未达标的冠心病及冠心病危险因素患者,分别于基线水平、停药前（即辛伐他汀20mg治疗4周后）及停用辛伐他汀1周时,采用高分辨超声技术检测肱动脉血流介导性扩张（FMD）评估血管内皮依赖性舒张功能,并测定一氧化氮（NO）、血浆内皮素（ET）、6-酮-前列腺素F1α（6-keto-PGF1α）和血栓素B2（TXB2）的水平及主要血脂参数的变化。结果 辛伐他汀治疗4周后可有效降低冠心病及冠心病危险因素患者TC、低密度脂蛋白胆固醇（LDL-C）水平,并明显改善患者肱动脉内皮依赖性舒张功能（FMD）。然而,停用辛伐他汀治疗1周后,所有患者肱动脉内皮依赖性舒张功能均较停药前明显下降（4．82士0．71）％与11．51±0．87％,P〈0．01）,甚至低于未服用辛伐他汀时的基线水平（4．82±0．71％与5．89±0．65％,P〈0．01）,其中冠心病患者停药后FMD下降幅度较仅有冠心病危险因素患者更显著（65．6％与56．3％,P〈0．01）。停药1周后,患者血清NO水平较停药前及基础值均明显降低,而血浆ET水平升高。血浆TXB,水平在停药前后无明显变化。此外,停药后患者血清LDL-C水平虽较治疗4周时有所升高,但仍未恢复至基线水平。停药后肱动脉FMD的变化仅与血清NO降低幅度呈正相关关系（r=0．674。P=0．004）,而与血清LDL-C水平变化无明显相关性（r=-0．414,P=0．083）。结论 在TC水平未达标的冠心病及冠心病危险因素患者中突然终止辛伐他汀治疗可在1周内完全逆转该药对血管内皮功能的改善作用,甚至还可能导致血管内皮功能进一步恶化。并且这种撤药反应随基础疾病的严重性增加。停药所致血管内皮功能损害可能与血管内皮源性的NO减少有关,是非胆固醇依赖性作用。     

阿托伐他汀对不同血脂水平的慢性心力衰竭患者血管内皮功能的影响

目的研究阿托伐他汀对不同血脂水平的慢性心力衰竭(CHF)患者血管内皮功能的影响。方法将131例CHF患者随机分为他汀治疗组66例〔阿托伐他汀20 mg/d,共12 w,正常血脂组,n=32;高脂血症组,n=34〕和对照组65例(正常血脂组,n=31;高脂血症组,n=34);各选择同期健康体检者60例作健康对照。运用无创超声检查技术,观察用药前后肱动脉内皮依赖性舒张功能(FMD)的变化,同时检测血清血管性假血友病因子(v WF)及6-酮-前列腺素F1α(6-keto-PGF1α)的浓度水平。结果治疗前CHF各组血清v WF水平较健康对照组明显升高(P0.01),FMD值和6-keto-PGF1α水平却显著下降(P0.01),FMD、v WF、6-keto-PGF1α与低密度脂蛋白胆固醇(LDL-C)存在显著相关性。治疗12 w后,CHF各组v WF水平明显降低,FMD和6-keto-PGF1α水平显著上升。与对照组比较,他汀治疗组的v WF降低更明显(P0.05),FMD和6-keto-PGF1α升高更为显著(P0.01)。他汀治疗组血脂水平较治疗前均明显下降(P0.05,P0.01)。结论阿托伐他汀治疗各血脂水平的CHF患者,可以有效改善CHF患者的血管内皮功能,这种改善作用独立于其调脂作用之外。     

氯沙坦对高血压患者血清一氧化氮、内皮素-1和血管内皮功能的影响

目的 探讨氯沙坦对高血压患者血清一氧化氮（NO）、内皮素-1（ET-1）和血管内皮功能的影响.方法 入选108例首诊轻、中度高血压患者,给予氯沙坦50～100 mg,qd,共12周;另人选同期健康体检者为正常对照组（对照组100例）.观察高血压患者治疗前后血流介导的肱动脉内皮依赖性血管舒张功能（FMD）、ET-1和NO的变化.结果 随访12周后,与治疗前比较,高血压患者的血压下降,FMD提高,NO上升,ET-1降低（均P〈0.05）.多元线性逐步回归显示,校正年龄、血压、血脂、血糖等因素后,ET-1和NO是FMD的影响因素（均P〈0.05）.结论 氯沙坦改善高血压患者血管内皮功能可能与减少内皮素分泌,增加一氧化氮水平有关.     

复方丹参注射液治疗2型糖尿病患者的临床研究

将2型DM患者分为丹参治疗组和对照组;另外选取48名健康人作为健康组.运用无创超声检查技术,观察用药前后颈动脉内-中膜厚度(IMT)及肱动脉内皮依赖性舒张功能(FMD)的变化,同时检测血清一氧化氮(N0)及内皮素-1(ET-1)的浓度水平.结果治疗前DM各组IMT值和血清ET-1水平较健康组明显升高(P＜0.01),FMD值和NO水平却显著下降(P＜0.01),IMT、FMD与NO存在着显著的相关性.治疗4周后,与对照组比较,IMT值和ET-1水平明显降低,FMD和NO水平显著升高.结论复方丹参注射液治疗2型DM患者,可以逆转或延迟颈动脉IMT的进程,改善血管内皮功能.     

不同剂量非洛地平对原发性高血压病患者内皮功能的影响

将69例高血压患者随机分为A、B、C三组各23例,分别予口服非洛地平5 、10、15 mg,1次/d,疗程5周.观察治疗前后血压、肱动脉内皮依赖性血管舒张功能变化,并检测血浆一氧化氮(NO)、内皮素-1(ET-1)水平.结果 用药后三组血压均明显下降,血浆NO水平均明显升高,血流介导的内皮依赖性舒张功能明显改善,ET-1水平明显降低,与A、B组比较,C组上述指标变化明显.认为非洛地平可明显改善高血压患者内皮功能,且改善程度随剂量增加而增高.     

缬沙坦对心脏X综合征患者内皮功能的影响及其临床意义

目的探讨缬沙坦对心脏X综合征患者血清一氧化氮(NO)、内皮素-1(ET-1)及内皮依赖性血管舒张功能的影响。方法 36例心脏X综合征患者给予缬沙坦80mg,1次/d,随访治疗12周,另入选同期健康体检者26例。复查心脏X综合征患者治疗前后NO、ET-1及血流介导的肱动脉内皮依赖性血管舒张功能(FMD)及运动平板试验的变化。结果用药12周后,与治疗前比较,心脏X综合征患者的NO上升和FMD提高(P<0.05);ET-1降低和最大ST段压低幅度明显降低(P<0.05);运动总时间、ST段压低1mm时间明显延长。结论缬沙坦可改善血管内皮功能,并提高患者的运动耐量。     

保利尔胶囊对冠心病患者血管内皮功能和C-反应蛋白水平的影响

目的 观察保利尔胶囊对冠心病患者血管内皮功能和C-反应蛋白(CRP)的影响.方法 选择冠心病患者87例,随机分为治疗组和对照组,对照组采用常规西药治疗;治疗组在常规西药治疗的基础上加用保利尔胶囊4粒/次,3次/日,服用1个月.观察两组治疗前后血管内皮依赖性舒张功能(EDD)、血浆内皮素-1(ET-1)、一氧化氮(NO)和CRP水平等指标的变化.结果 治疗后,治疗组ET-1均明显下降(P＜0.05),NO明显升高(P＜0.05),但治疗组ET-1、NO较对照组变化更明显(P＜0.05).治疗后的肱动脉EDD,治疗组为(9.67±3.10)％较对照组(4.32±2.78)％明显改善(P＜0.05);而肱动脉内皮非依赖性血管舒张功能(NMD)也得到明显改善(P＜0.05).结论 保利尔胶囊可使血浆ET-1水平明显下降,NO水平明显升高,EDD、NMD明显改善,CRP明显降低,提示保利尔胶囊有显著保护血管内皮功能、抑制炎症和改善临床症状的作用.     

老年高血压病并下肢动脉硬化症的血管内皮功能

目的了解老年高血压病及高血压病合并下肢动脉硬化症(LEASD)患者内皮依赖性舒张功能(FMD)、非内皮依赖性舒张功能(NMD)以及血浆一氧化氮(NO)、内皮素(ET)的水平。方法采用高分辨率超声诊断系统分别检测36例老年高血压病(老年高血压组)患者以及49例老年高血压病合并LEASD(老年高血压合并LEASD组)患者肱动脉的FMD及NMD;同时采用硝酸盐镉还原、比色法测定NO水平(以硝酸盐浓度表示);采用放射免疫法检测ET水平,并分别与40例健康老人(健康老年组)进行对照研究。结果老年高血压合并LEASD组患者肱动脉的FMD及NMD均显著低于老年高血压组和健康老年组(P<0.05),而老年高血压组患者的FMD和NMD亦显著低于健康老年组(P<0.05);老年高血压合并LEASD组患者的NO水平显著低于老年高血压组和健康老年组,而ET却显著高于老年高血压组和健康老年组,而老年高血压组患者NO水平同样显著低于健康老年组,ET水平显著高于健康老年组(P<0.05)。结论老年高血压病及高血压病合并LEASD患者肱动脉FMD及NMD均受损;老年高血压病及高血压病合并LEASD患者均存在血管内皮功能失调,且高血压病合并LEASD患者内皮功能紊乱更严重。     

复方丹参注射液治疗2型糖尿病患者的临床研究

将2型DM患者分为丹参治疗组和对照组；另外选取48名健康人作为健康组。运用无创超声检查技术，观察用药前后颈动脉内-中膜厚度（IMT）及肱动脉内皮依赖性舒张功能（FMD）的变化，同时检测血清一氧化氮（NO）及内皮素-1（ET-1）的浓度水平。结果：治疗前DM各组IMT值和血清ET-1水平较健康组明显升高（P〈0．01），FMD值和NO水平却显著下降（P〈0．01），IMT、FMD与NO存在着显著的相关性。治疗4周后，与对照组比较，IMT值和ET-1水平明显降低，FMD和NO水平显著升高。结论：复方丹参注射液治疗2型DM患者，可以逆转或延迟颈动脉IMT的进程，改善血管内皮功能。     

辛伐他汀对冠心病合并糖耐量减低患者内皮依赖性血管舒张功能的影响

随机将入选冠心病合并糖耐量减低患者分为降脂治疗组(辛伐他汀5～10mg/d,连服6个月)及对照组.观察治疗前后血脂的改变;应用高分辨率超声,检测两组治疗前后肱动脉内皮依赖性及非内皮依赖性血管内径与血流变化.结果冠心病合并糖耐量减低患者内皮依赖性血管扩张(FMD)及硝酸甘油介导的血管扩张(NTG-MD)明显降低辛伐他汀治疗后,随血脂改善,FMD提高,但非FMD未见改善.结论辛伐他汀治疗能够改善冠心病合并糖耐量减低患者的FMD.     

辛伐他汀对冠心病患者血管内皮细胞功能障碍的治疗作用（英文）

目的：研究辛伐他汀对冠心病患者血管内皮细胞功能障碍的干预作用。方法：90例冠心病患者按LDL-C水平分为三组：辛伐他汀20mg组（37例,LDL-C≥2.5mmol/L）,辛伐他汀10mg组（35例,2.5mmol/L〉LDL-C≥1.8mmol/L）,常规治疗组（18例,LDL-C〈1.8mmol/L,未服辛伐他汀）,疗程均为8周。应用彩色多普勒超声诊断仪测量受试者肱动脉血流介导的舒张功能（FMD）。应用硝酸还原酶法检测受试者一氧化氮（NO）的含量。常规检测血清TC、TG、LDL-C及HDL-C的浓度。结果：8周后,与治疗前比较,辛伐他汀20mg,10mg组TC、TG和LDL-C浓度明显下降（P均〈0.05）,而HDL-C明显升高（P均〈0.05）;辛伐他汀20mg组与10mg组间各指标差异无显著性（P〉0.05）;与常规治疗组比较,辛伐他汀20mg、10 mg组FMD[（6.01±0.49）%比（9.01±0.39）%比（9.01±0.47）%]明显改善（P均〈0.01）、血清NO含量[（38.97±8.89）μmol/L比（47.67±10.89）μmol/L比（45.61±9.09）μmol/L]明显升高（P均〈0.05）,辛伐他汀20mg、10 mg组两组间NO和FMD亦无显著差异（P〉0.05）。结论：辛伐他汀可增加冠心病患者一氧化氮含量,改善血管内皮细胞功能,其作用机制与降低血清总胆固醇、甘油三酯和低密度脂蛋白可能有一定关系,但该作用无明显的量效关系,可能独立于降脂作用之外。     

Early statin therapy restores endothelial function in children with familial hypercholesterolemia

OBJECTIVES: This study was designed to determine whether simvastatin improves endothelial function in children with familial hypercholesterolemia (FH). BACKGROUND: Endothelial function measured by flow-mediated dilation of the brachial artery (FMD) is used as a surrogate marker of cardiovascular disease (CVD). Adult studies have shown that statins reverse endothelial dysfunction and therefore reduce the risk for future CVD. METHODS: The study included 50 children with FH (9 to 18 years) and 19 healthy, non-FH controls. Children with FH were randomized to receive simvastatin or placebo for 28 weeks. The FMD was performed at baseline and at 28 weeks of treatment. RESULTS: At baseline, FMD was impaired in children with FH versus non-FH controls (p < 0.024). In the simvastatin FH group, FMD improved significantly, whereas the FMD remained unaltered in the placebo FH group throughout the study period (absolute increase 3.9% +/- 4.3% vs. 1.2% +/- 3.9%, p < 0.05). In the simvastatin FH group, FMD increased to a level similar to the non-FH controls (15.6% +/- 6.8% vs. 15.5% +/- 5.4%, p = 0.958). Upon treatment, the simvastatin FH group showed significant absolute reductions of total cholesterol (TC) (-2.16 +/- 1.04 mmol/l, 30.1%) and low-density lipoprotein cholesterol (LDL-C) (-2.13 +/- 0.99 mmol/l, 39.8%). The absolute change of FMD after 28 weeks of therapy was inversely correlated to changes of TC (r = -0.31, p < 0.05) and LDL-C (r = -0.31, p < 0.05). CONCLUSIONS: Our data show significant improvement of endothelial dysfunction towards normal levels after short-term simvastatin therapy in children with FH. These results emphasize the relevance of statin therapy in patients with FH at an early stage, when the atherosclerotic process is still reversible.     

Short-term withdrawal of simvastatin induces endothelial dysfunction in patients with coronary artery disease: a dose-response effect dependent on endothelial nitric oxide synthase

BACKGROUND: Patients with coronary artery disease (CAD) have impaired endothelial function. Simvastatin therapy has been demonstrated to significantly improve endothelial function in these patients. Although withdrawal of statins is a frequent problem in clinical practice, the effects after discontinuation of statins treatment on endothelial function in patients with CAD are largely unknown. OBJECTIVE: This study investigated the effects after withdrawal of simvastatin on brachial artery endothelial function in patients with CAD and the underlying mechanisms. METHODS: We recruited 30 patients with established CAD. They were treated with 20 mg simvastatin for 4 weeks. Endothelial dependent flow-mediated vasodilation (FMD) was assessed in the brachial artery using high-resolution ultrasound at baseline, 4 weeks during simvastatin treatment, and 1 week after termination of therapy. 20 healthy subjects were also studied as a control group. Furthermore, we investigated underlying mechanisms on human umbilical vein endothelial cells (HUVECs) confluent monolayers at passages 2-3. HUVECs were exposed to simvastatin. After 24 h cells were repeatedly washed to remove the drugs, and the conditioned mediums were collected at the indicated time points. The nitric oxide (NO) production and levels of eNOS mRNA after 24 h of withdrawal of statins were examined. RESULTS: (1) Abrupt discontinuation of simvastatin treatment leads to a rebound of serum total cholesterol (21.3%) and LDL cholesterol (18.2%) in patients within 1 week, but they were still lower than the baseline values (P<0.05 for each parameter). (2) A significant decreased of FMD (-59.3%) was observed in patients after discontinuation of simvastatin in 1 week, and furthermore, the FMD was even lower than the baseline levels (4.6% vs. 5.6%, P<0.05). The reduction of FMD was not correlated with the change of LDL cholesterol (r=-0.343, P=0.081). In contrast to the unchanged LDL cholesterol level, abrupt discontinuation of therapy caused a rapid and significant decrease in FMD from 10.6% to 5.2% in healthy subjects at day 1, but it returned to baseline levels within 1 week. (3) In HUVECs, a maximum decrease of nitrite levels (-80%) was observed at 6 h after stopping simvastatin treatment, which was below the control levels. 24 h after stopping 10(-5) mmol/L and 10(-6) mmol/L simvastatin treatment, eNOS mRNA expression decreased to -71% and -42% (P<0.05), respectively. CONCLUSIONS: Abrupt withdrawal of simvastatin treatment not only acutely and completely abrogates its beneficial effects on endothelial function in patients with CAD, but also induced further vascular injury compared with pretreatment status, independent of cholesterol levels. The underlying mechanism of these negative effects may be related to the suppression of endothelial NO production, which are dose-dependent.     

辛伐他汀对冠心病患者血管内皮功能作用的量效关系

目的探讨不同剂量(5mg,10mg,20mg)的辛伐他汀对冠心病患者血管内皮功能的作用及其量效关系。方法共入选80例冠心病患者,随机分为4组:对照组(不服用辛伐他汀),辛伐他汀5 mg组、辛伐他汀10 mg组、辛伐他汀20 mg组、每组20例,治疗8周。采用超声法检测血流介导的肱动脉内皮依赖性舒张功能(FMD),同时观察血脂水平的变化。结果辛伐他汀治疗8周后,5 mg、10 mg、20 mg呈剂量依赖性显著降低血总胆固醇(分别降低9%,18%,29%)和低密度脂蛋白胆固醇水平(分别降低12%、24%、35%),不同剂量组间P<0.05。对照组治疗8周后血脂水平无明显变化(P>0.05)。5 mg、10 mg、20 mg的辛伐他汀均可显著改善FMD[5mg:(3.41±2.99)%VS(7.46±5.11)%;10mg:(3.76±3.01)%比(7.98±4.92)%;20mg:(3.59±3.47)%比(8.09±6.10)%;P均<0.01]。但三组之间FMD的变化值比较无显著差异(P>0.05),且FMD的改善与血TC、LDL-C水平的降低不相关。对照组FMD虽有轻度增加,但无统计学意义。辛伐他汀治疗后肱动脉内径、肱动脉对硝酸甘油的反应均无显著改变。结论辛伐他汀5 mg、10 mg、20 mg治疗8周后,可显著改善冠心病患者血管内皮功能,但该作用无明显的量效关系,可能独立于调脂作用之外。     

不同剂量辛伐他汀对冠状动脉粥样硬化症患者血管内皮细胞功能的影响

目的观察不同剂量辛伐他汀对冠状动脉粥样硬化症患者血管内皮细胞功能的影响。方法纳入133例冠状动脉粥样硬化症患者,依据低密度脂蛋白胆固醇(LDL-C)水平将入组患者分为4组:LDL-C≥4.16 mmol/L患者30例,给予辛伐他汀40 mg/d干预治疗(40 mg组);3.64 mmol/L≤LDL-C4.16mmol/L患者35例,给予辛伐他汀20 mg/d干预治疗(20 mg组);2.6 mmol/L≤LDL-C3.64 mmol/L患者37例,给予辛伐他汀10 mg/d干预治疗(10 mg组),LDL-C2.6 mmol/L患者31例,不给予辛伐他汀治疗(对照组)。应用彩色多普勒超声诊断仪测量受试者肱动脉血流介导的舒张功能(FMD)及硝酸甘油介导的舒张功能(NMD),应用硝酸酶还原法检测受试者血清一氧化氮的含量。常规检测血清总胆固醇、甘油三酯、低密度脂蛋白及高密度脂蛋白的水平。结果治疗前,辛伐他汀干预组(10 mg组、20 mg组、40 mg组)患者血清NO水平与对照组比较无统计学差异(P0.05)。治疗8周后,辛伐他汀干预组(10mg组、20 mg组、40 mg组)患者NO水平显著升高,与治疗前比较,有明显统计学差异(P0.05);与对照组比较有统计学差异(P0.05)。对照组患者治疗前后NO水平无明显变化(P0.05)。治疗前,辛伐他汀干预组(10 mg组、20 mg组、40 mg组)患者肱动脉内径基础值、FMD及NMD水平与对照组比较均无统计学差异(P0.05)。治疗8周后,辛伐他汀干预组(10 mg组、20 mg组、40 mg组)患者肱动脉内径基础值、NMD水平与治疗前比较,无统计学差异(P0.05);FMD水平较治疗前显著增加,与对照组比较也呈明显增加趋势,差异有统计学意义(P0.05);NMD水平与与照组比较,差异无统计学意义(P0.05)。结论辛伐他汀可增加冠状动脉粥样硬化症患者血清一氧化氮水平,改善血管内皮细胞功能,其作用机制与改善血脂水平无明显的量效关系。     

辛伐他汀对冠心病患者血管内皮功能作用的时效关系

目的探讨辛伐他汀改善冠心病患者血管内皮功能的时效关系。方法共入选30例确诊冠心病患者,每天服用辛伐他汀20mg,进行1年随访。采用超声法检测血流介导的肱动脉内皮依赖性舒张功能(flow mediated dila-tion,FMD),同时观察血脂水平、肝肾功能、血糖以及心肌酶学的变化。结果完成50周随访的25例冠心病患者,辛伐他汀(20mg/d)服后2周、4周、8周、12周及50周可分别使患者血清总胆固醇(TC)降低18.9%、24.3%、29.0%、30.1%、29.4%,低密度脂蛋白胆固醇(LDL-C)降低20.1%、26.8%、34.7%、36.0%、35.2%。辛伐他汀治疗可显著改善冠心病患者的血管内皮功能,FMD较治疗前明显增加,2周:64%,4周:95%,8周:123%,12周:179%,52周:142%(2周、4周P<0.05;8周、12周、52周P<0.01)。FMD的改善与血清TC和LDL-C降低水平无显著相关,而与基础FMD有关。所有患者耐受性好,无明显不良反应。结论辛伐他汀治疗冠心病患者2周时,血管内皮功能即有改善,8~12周达高峰,长期治疗能产生持续的血管内皮功能改善。     

Protective effect of high density lipoprotein on endothelium-dependent vasodilatation

Low concentrations of high-density lipoprotein cholesterol (HDL-C) have been associated with increased risk of coronary heart disease (CHD) even when the total cholesterol (TC) and triglyceride (TG) levels are not elevated. The mechanism by which HDL confers protection against atherosclerosis remains speculative. Using high-resolution ultrasound, we measured the dilatation changes of brachial arteries during reactive hyperemia and after sublingual glyceryl trinitrate (GTN) in 63 patients with established (CHD) and 45 controls, in which the serum TC level was normal. The results showed that both flow-mediated dilatation (FMD) and GTN-induced dilatation of brachial arteries in patients with CHD were much reduced compared with control group (2.31+/-2.46% vs. 7.43+/-4.10% and 16.41+/-6.15% vs. 22.44+/-8.63%, respectively, P<0.001 for all). Univariate analysis indicated that FMD of brachial arteries was inversely related to age (r=-0.226, P<0.05), hypertension (r=-0.229, P<0.05), baseline diameter (r=-0.299, P<0.01) and LDL-C (r=-0.237, P<0.05) and positively related to HDL-C (r=0.491, P<0.01). GTN induced vasodilatation was inversely related to age (r=-0.216, P<0. 05) and baseline diameter (-0.476, P<0.01). Multiple stepwise regression analyses in two groups taken together showed that HDL-C and age were the independent predictors of the FMD of brachial arteries (beta=0.466, P=0.000 and beta=-0.184, P=0.020, respectively). Baseline diameter was significant predictor of GTN-induced vasodilatation (beta=-0.390, P=0.000). The analysis in the group of CHD patients showed that only HDL-C was significantly relate to the FMD of brachial arteries (beta=0.295, P=0.018 ) and in controls that hypertension and HDL-C were significantly relate to the FMD of brachial arteries (beta=-0.395, P=0.004 and beta=0.344, P=0.011, respectively). These finding suggest that endothelium-dependent and endothelium-independent vasodilatation are impaired in the patients with CHD. HDL exerts a protective effect on endothelium-dependent vasodilatation in TC being relatively normal population.     

两种不同剂量辛伐他汀对冠心病患者血管内皮功能的影响

目的探讨辛伐他汀10 mg与20 mg不同剂量对冠心病患者血管内皮功能作用的影响。方法共入选66例冠心病患者,随机分为对照组、辛伐他汀10 mg组和辛伐他汀20 mg组,治疗8周。采用超声法检测血流介导的肱动脉内皮依赖性舒张功能,同时观察血脂水平的变化。结果辛伐他汀治疗8周后,10 mg和20 mg辛伐他汀呈剂量依赖性显著降低血总胆固醇和低密度脂蛋白胆固醇水平(总胆固醇分别降低18.3%和29.3%;低密度脂蛋白胆固醇分别降低25.3%和35.4%;P<0.05)。对照组治疗8周后血脂水平无明显变(P>0.05)。10 mg和20 mg辛伐他汀均可显著改善肱动脉内皮依赖性舒张功能(10 mg辛伐他汀组为3.51%±4.03%比7.46%±5.90%;20mg辛伐他汀组为3.89%±3.97%比7.98%±6.16%;P均<0.01)。但两组之间肱动脉内皮依赖性舒张功能的变化值比较差异无显著性(P>0.05),且肱动脉内皮依赖性舒张功能的改善与血总胆固醇和低密度脂蛋白胆固醇水平的降低不相关。对照组肱动脉内皮依赖性舒张功能虽有轻度增加,但无统计学意义。辛伐他汀治疗后肱动脉内径和肱动脉对硝酸甘油的反应均无显著改变。结论10 mg和20 mg辛伐他汀治疗8周后,可显著改善冠心病患者血管内皮功能,但该作用在这2种剂量之间无显著不同,可能独立于调脂作用之外。     

Association between wall shear stress and flow-mediated vasodilation in healthy men

Wall shear stress contributes to the endothelial production of vasoactive mediators, like nitric oxide (NO). Brachial artery vasodilation that follows increased blood flow is regulated by NO release. Aim of the present study was to investigate whether resting wall shear stress of the brachial artery is related to flow-mediated vasodilation (FMD) induced by forearm ischemia. Wall shear stress was calculated according to the following formula: Wall shear stress=Blood viscosity x Blood velocity/Internal diameter. FMD was calculated as percentage change of brachial artery diameter following forearm ischemia. Twenty-seven healthy male subjects were investigated. Peak wall shear stress and FMD were 37.3+/-12.8 dynes/cm(2) and 110.7+/-5.6%, respectively (mean+/-S.D.). In simple regression analyses, age was inversely associated with wall shear stress (r=48, P<0.01) and, marginally, with FMD (r=0.33, P=0.08). Wall shear stress and FMD were directly related (r=0.60, P<0.001). In multiple regression analysis, including wall shear stress, age, blood pressure, lipids, glucose and Body Mass Index as independent variables, wall shear stress was the only variable independently associated with FMD (standardized beta coefficient=0.690, P相似文献