代谢综合征患者血管内皮功能与血栓前状态的相关性研究

目的：探讨代谢综合征（MS）患者血管内皮功能损伤、血栓前状态及两者间的关系。方法：选择46例MS患者及正常对照组20例。MS患者根据有无颈动脉斑块分为两组，Ⅰ组（无斑块）22例，Ⅱ组（有斑块）24例。采用高分辨率超声技术检测肱动脉血管血流介导的血管舒张功能（FMD）和硝酸甘油诱导的血管舒张功能（NMD）．同时记录颈动脉内膜中层厚度（IMT），并分别测定血浆一氧化氮（NO）、血管性假性血友病因子（vWF）、组织纤溶酶原激活物（t-PA）、Ⅰ型组织纤溶酶原激活物抑制物（PAI-1）、血栓素岛（TXB2）及6-酮前列腺素Fla（6-k—PGFla）水平，并进行相互比较。结果：MS组FMD均显著低于对照组（P〈0．05）。MSⅡ组与对照组之间NMD和IMT有显著性差异（P均〈0．05）。MS组NO、t—PA和6-k—PGFla水平显著低于对照组，vWF、PAI-1和TXB2水平显著高于对照组（P均〈0．01）；MSⅡ组NO和6-k—PGFla水平显著低于MSI组，vWF、PAI—1和TXB2水平显著高于MSI组（P〈0．05～〈0．01）。经直线相关分析显示：NO、FMD与t—PA和6-k—PGFla呈正相关（r=0．32～0．52，P均〈0．05）；NO、FMD与vwF、PAI—1和TXB2呈负相关（r=-0．69～-0．47。P均〈0．05）。结论：MS患者血管内皮功能明显受损，存在血栓前状态，可能是易并发缺血性心脑血管疾病的原因之一。

Relationship between the endothelial function and pre-thrombotic state in metabolic syndrome

Objective： To discuss the endothelial function, pre-thrombotic state and the relationship of both in patients with metabolic syndrome （MS）. Methods： A total of 46 MS patients and 20 healthy subjects were enrolled in the study. The MS patients were divided into two subgroups according to presence of carotid plaque or not. Flow mediated dilation （FMD）, nitroglycerin-mediated vasodilation （NMD） of brachial artery and intima-medial thickness （IMT） of carotid artery were measured with high-resolution ecbocardiography in patients and healthy people. The plasma levels of NO, vWF, t-PA, PAI-1, TXB2 and 6-k-PGFla were assayed at the same time. Results： There were significant differences of changes in FMD between control subjects and MS patients （P〈0.05）, and significant differences of changes in NMD and IMT between control subjects and MS subgroup Ⅱ were also observed （P〈0.05）. Compared with control group, the levels of NO, t-PA, and 6-k-PGFla were lower in MS patients （P〈0. 01）, while the levels of vWF , PAI-1, TXB2 were higher （P%0.01）. Compared with MSI group, the levels of NO, and 6-k- PGFla were lower in MSⅡ group, while the levels of vWF, PAI-1 and TXB2 were higher （P〈0.05-〈0.01） . There was positive correlations between plasma NO, FMD and plasma t-PA, 6-k-PGFla （r=0.32-0.52, P〈 0.05）, while plasma NO, FMD was negatively related with plasma vWF, PAI-1, and TXB2 （r=-0.69-0.47, P〈0.05）. Conclusion： There are endothelium dysfunction, pre-thrombotic state in metabolic syndrome patients, which may be the pathogenesis of complication such as ischemic stroke and heart attacks.