变异性心绞痛患者血管内皮功能相关指标测定的临床意义

目的研究变异性心绞痛(VAP)患者血管内皮功能相关指标的变化。方法征集疑为冠状动脉性心脏病(CAD)或电生理研究提示心律失常而行诊断性心导管术的住院患者共93例,根据相关诊断标准将其分为3组,其中 VAP 患者39例,劳力性心绞痛(EAP)患者35例,对照组19例。根据临床症状的严重度,将 VAP组再分为轻度 VAP 组22例和重度 VAP 组17例。采集血样分别测定各组患者的白细胞(WBC)及分类计数、血浆纤维蛋白原(Fbg)、内皮素(ET-1)、血管性血友病因子(vWF)、C-反应蛋白(CRP)以及冠心病(CHD)其他危险因子,如总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)等的变化。结果除 EAP 组高密度脂蛋白胆固醇(HDL-C)明显低于对照组外(P<0.01)。其他CHD 危险因子、体温、WBC 总数、CRP 等在 VAP、EAP 及对照组间差异无显著性意义(P>0.05)。而重度 VAP组 EOS 明显高于其他三组(P<0.01)。重度 VAP 组血浆 Fbg、ET-1和 vWF 也明显高于其他3组(P<0.05)。VAP 患者经药物治疗后,EOS 计数、血浆 Fbg、ET-1和 vWF 明显低于对照组(P<0.01)。结论 EOS 计数和血浆 Fbg,ET-1和 vWF 水平可预示 VAP 病情严重度,提示冠状动脉痉挛可能引起 EOS 和 Fbg、ET-1和 vWF 水平升高。

Clinical Signification of Determination of Vascular Endothelium Function Markers in Patients with Variant Angina Pectoris.

Objective To investigate the clinical signification of determination of vascular endothehum function markers in patients with variant angina pectoris(VAP).Methods All subjects(n=93)were elected from patients who were hospi- talized for diagnostic catheterization because of suspected corenary artery disease or for the electrophysiologic study of arrhyth- mia.The patients were divided into 3 groups according to the criteria of diagnosis.The VAP group(n=39)who had sponta- neous angina attacks,the stable angina pectoris(EAP)group(n=35)and control group(n=19).Patients with VAP were further divided into mild VAP(n=22)and severe VAP(n=17)based on the severity of symptoms.Fasting vein blood were collected for differential and white blood ceils(WBC)counts,fibrinogen(Fbg),endothelin-1(ET-1),yon willebrand factor (vWF) and C-reactive protein(CRP),and other risk factors of coronary heart disease(CHD)such as total Choles- terel(TC),triglyceride(TG),high density lipoprotein-Cholesterol(HDL-C)and low density lipopretein-Cholesterol (LDL-C),et al.Results There were no significant differences among the control,VAP,EAP groups,except for the HDL-C levels in the EAP group were significantly lower than those in the control group(P<0.01).In addition,the CRP levels,WBC,red blood cells(RBC)and platelet(PLT)counts did not differ among the4 groups(P>0.05).In con- trast,There were a significant increase in the eosinophil counts in the severe VAP group compared with the other 3 groups( P<0.01),the plasma fibrinogen,ET-1 and vWF levels were significantly higher in the severe VAP group than that in the other 3 groups(P<0.05).The eosinophil counts,plasma fibrinogen,ET-1 and vWF after medical therapy in patients with VAP were reduced significantly to the same levels as those in the control group(P<0.01).Conclusion The eosino- phil counts and plasma fibrinogen,ET-1 and vWF levels could predict the severity of VAP.This study suggests that coro- nary vasospasm could result in an increase in eosinophil counts and plasma fibrinogen,ET-1 and vWF levels.