血浆不对称二甲基精氨酸水平与冠状动脉硬化关系的研究

目的研究不对称二甲基精氨酸（ADMA）水平是否与冠状动脉粥样硬化的病变范围和严重程度有关。方法110例行冠状动脉造影术的患者根据造影结果分为冠状动脉造影正常的对照组22例,轻度动脉硬化组21例,造影显示冠状动脉内膜不光滑,但无明显的狭窄或狭窄小于50％;单支病变组22例,造影显示1支主要的冠状动脉分支出现明显狭窄（≥50％）;双支病变组22例,两支主要的冠状动脉分支出现明显狭窄;多支病变组23例,两支以上主要的冠状动脉分支出现明显狭窄或伴有左主干病变。血浆ADMA水平的检测采用酶联免疫法。结果除轻度动脉硬化组ADMA水平（1．21μmol／L±0．36μmol／L,P=0．288）偏低外,单支病变组、双支病变组和多支病变组患者的ADMA水平均高于对照组（1．52μmol／L±0．61μmol／L,1．67μmol／L±0．80μmol／L和2．60μmol／L±0．62μmol／L vs 0．79μmol／L±0．54μmol／L,P〈0．01）。经过多元相关与Logstic等级回归分析,ADMA水平与冠状动脉病变程度密切相关。结论血浆ADMA水平升高可以预测冠状动脉粥样硬化的发生,ADMA可能是一种新的冠心病危险因子。

Relationship between plasma asymmetrical dimethylarginine and coronary artery disease

OBJECTIVE: To investigate whether the plasma asymmetrical dimethylarginine (ADMA) level correlates with the extent and severity of coronary atherosclerosis. METHODS: 110 consecutive patients undergoing coronary angiography were divided into five groups according to the result thereof: control group (n = 22, with normal coronary artery), mild coronary artery disease (CAD) group (n = 21, with stenosis < 50% of the major coronary arteries), single branch CAD group III (n = 22, with stenosis >/= 50% of one major coronary artery); double branch CAD group IV (n = 23, with stenosis >/= 50% of two major coronary arteries); and multi-branch CAD group (n = 22, with significant stenosis >/= 50% of more than two major coronary arteries or companied with stenosis of left major coronary). ELISA was used to detect the plasma ADMA. Nitric acid reductase method and colorimetry were used to measure the levels of plasma nitric oxide (NO) and nitrogen oxide synthase (NOS). The relationship between the plasma ADMA and severity of CAD was analyzed. RESULTS: The plasma ADMA levels of in last three a groups were 1.52 micromol/L +/- 0.61 micromol/L, 1.67 micromol/L +/- 0.80 micromol/L, and 2.60 micromol/L +/- 0.62 micromol/L all significantly higher than that of the control group (0.79 micromol/L +/- 0.54 micromol/L, P < 0.01). The plasma NO and NOS levels of the multi-branch CAD group were significantly lower than those of the other groups (all P < 0.01), and there were not significant differences in Plasma NO and NOS levels among the other groups. Multivariate stepwise logistic regression analysis showed that the plasma ADMA level was significantly positively correlated with the severity of coronary atherosclerosis (r = 0.684, P = 0.007) and total cholesterol and triglyceride (r = 0.623 and 0.536 respectively), and significantly negatively correlated with the NO and NOS levels (r = -0.709 and -0.701 respectively). CONCLUSION: Correlated significantly with the severity of coronary atherosclerosis, the plasma ADMA level may become a novel marker of CAD.