内皮素、内皮素/一氧化氮比值与心脏X综合征心肌血流灌注的关系

目的评价心脏X综合征运动前后内皮素（ET-1）、内皮素/一氧化氮（ET-1/NO）比值变化与运动诱发心肌血流灌注变化相关性。方法选取心脏X综合征（X综合征组）20例,对照组为健康体检者15例。两组均在静息时和运动高峰时抽取静脉血,分别测定血浆ET-1、NO水平。通过核素心肌灌注显像,评价其心肌血流灌注情况。结果（1）X综合征组运动高峰ET-1、ET-1/NO值较运动前明显升高,对照组运动高峰ET-1/NO比值较运动前下降（P〈0.01或P〈0.05）。运动高峰时X综合征组ET-1、ET-1/NO比值较对照组明显增高（P〈0.05）。（2）运动达标时X综合征组ET-1、ET-1/NO比值与心肌灌注异常缺血总评分（缺血节段×缺血评分）呈明显正相关（r=0.607,P〈0.01;r=0.892,P〈0.001）。结论X综合征患者ET-1、ET-1/NO比值异常升高,提示其存在内皮功能障碍;X综合征患者ET-1和ET-1/NO比值升高与心肌血流灌注异常呈正相关。提示ET-1和ET-1/NO比值为心肌缺血发生的重要介质,在一定程度上反映心肌缺血程度。

The relationship between endothelin, endothelin to nitric oxide ratio and myocardial perfusion in patients with cardiological syndrome X

Objective The purpose of this study was to evaluate the relation between myocardial perfusion and endothelin(ET-1) and ET-1/NO ratio in patients with cardiological syndrome X.Methods Twenty patients with cardiological syndrome X(group A) and fifteen healthy volunteers as control(group B) were involved.Blood sample was taken at rest and maximum exercise respectively.99Tcm-MIBI myocardial scintigrams were performed in all patients.Qualitative and semi-quantitative methods were used to evaluate the characteristics of myocardial perfusion in patients with cardiological syndrome X.Results(1)ET-1 and ET-1/NO in group A increased significantly(P<0.001 and P<0.05) and ET-1/NO decreased significantly in group B(P<0.05) at maximum exercise compared to at rest.ET-1 and ET-1/NO in group A were significantly higher than that in group B at maximum exercise(P<0.05).(2)At maximum exercises,ET-1,ET-1/NO were positively correlated with myocardial perfusion defect total score(amounts of defect segments multiply defect score),(r=0.607,P<0.01;r=0.892,P<0.001,respectively)in group A.Conclusions(1)The significant increases of ET-1 and ET-1/NO indicate endothelial dysfunction in syndrome X.(2)The increases of ET-1 and ET-1/NO were positively correlated with myocardial ischemia in cardiological syndrome X.ET-1 and ET-1/NO were important medium of myocardial ischemia and indicate the perfusion level a certain extent.