体外反搏对血液不对称二甲基精氨酸和内皮素的影响

目的：经皮冠状动脉腔内成形和支架植入术（PTCA+stent）后的冠心病患者经过增强型体外反搏治疗后，观察其血清不对称二甲基精氨酸（ADMA）和内皮素-1（ET-1）水平的变化，从而反映体外反搏对血管内皮功能的影响。方法:将51名冠心病患者（PTCA+stent后）分成两组，按 1∶2 匹配，反搏组17人，对照组34人。两组均给予常规的药物治疗，此外，反搏组予以3个疗程的体外反搏治疗。ADMA采用高效液相色谱-荧光法检测，ET-1采用放射免疫法检测。结果:反搏组在治疗后ADMA和 ET-1水平明显低于治疗前（P<0.05）；对照组治疗前后ADMA差异无显著（P>0.05），ET-1在治疗后高于治疗前（P<0.01）。组间比较，反搏组的ADMA和ET-1降低程度明显多于对照组（P<0.01）；反搏组心绞痛症状改善和心绞痛减少次数均较对照组明显（P<0.01），并且ADMA降低的程度与两者呈正相关（r分别是0.85、0.70，P<0.01） 。结论：增强型体外反搏通过提高对血管内皮细胞的切应力，降低了PTCA+stent术后冠心病患者血液中的ADMA、ET-1，提示血管内皮功能的改善，为冠心病患者的综合治疗提供了实验依据。

Effect of external counterpulsation on asymmetry diethylarginine and endothelin levels in blood

AIM:To observe changes of serum asymmetry dimethylarginine (ADMA) and endothelin-1 (ET-1) levels,which reflect blood vessel endothelial function,after therapy of enhanced external counterpulsation(EECP) in patients who had taken percutaneous transluminal coronary angioplasty and stent.METHODS:Fifty one coronary heart disease patients (all of them had taken percutaneous tranluminal coronary angioplasty and stent) were distributed into two groups by matching them with ratio of 1∶2,17 patients in EECP group and 34 patients in control group.Both of two groups were given conventional medicine,in addition,EECP group was undertaken three courses of treatment of EECP.ADMA was detected by HPLC-fluorescence method,and ET-1 was detected by radio-immunity method.RESULTS:In EECP group ，compared with prior treatment,ADMA and ET-1 levels was obviously reduced (P<0.05).In control group,compared with prior treatment,ADMA had no significant difference (P>0.05) and ET-1 was higher (P<0.01).Compared between two groups,extent of decrease in ADMA and ET-1 levels in EECP group were more obvious than control group (P<0.01).Improvement of angina and decrease of frequency of angina was more obvious in EECP group than control group.Besides,decrease of ADMA level was positive correlation with them (r=0.85，0.70,respectively P<0.01).CONCLUSION:EECP reduces serum ADMA and ET-1 levels by increasing shear stress to vessel endothelium in coronary heart disease patients who had taken percutaneous tranluminal coronary angioplasty.It hints that EECP can improve endothelial function and provides experimental evidence for the combined treatment of coronary heart disease.