冠状动脉造影中血压升高患者冠状动脉狭窄与血管内皮功能及炎症因子的相关性研究

目的探讨冠状动脉造影中血压升高的非高血压患者的冠状动脉狭窄与血管内皮功能及炎症因子的相关性。方法选择1141例疑诊冠心病的非高血压患者,所有患者均行冠状动脉造影检查,其中将冠状动脉造影过程中监测收缩压升高≥30 mm Hg（1 mm Hg=0.133 kPa）和（或）舒张压升高≥15 mm Hg的患者分为观察组,反之为对照组,测定两组患者一氧化氮（NO）、肱动脉介导的血管内皮功能（FMD）及超敏C反应蛋白（hs-CRP）、可溶性白细胞分化抗原配体（sCD40L）水平。观察术中血压升高者其冠状动脉狭窄与血管内皮功能及炎症因子的关系。结果两组术前及术后血压比较,差异均无统计学意义。冠状动脉造影结果显示,对照组以正常和狭窄〈50%为主,而观察组则以狭窄〈50%和狭窄≥50%为主,观察组冠状动脉狭窄≥50%者比例显著高于对照组（χ2=79.87,P〈0.05）,而对照组冠状动脉造影正常者比例显著高于观察组（χ2=79.87,P〈0.05）。观察组血浆NO水平（P=0.004）及代表血管内皮依赖性舒张功能的FMD（P=0.023）显著低于对照组;而代表炎症反应的hs-CRP（P=0.036）及sCD40L（P=0.015）显著高于对照组。结论冠状动脉造影术中血压升高的非高血压患者已存在冠状动脉狭窄、血管内皮功能障碍及血浆炎症因子升高。

The relation between coronary artery stenosis and vascular endothelial function and inflammatory in patients with elevated blood pressure who received during the coronary artery angiography

Objective To investigate the relation between coronary artery stenosis,vascular endothelial function and inflammatory in non-hypertensive patients with elevated blood pressure coronary angiography. Methods We selected 1141 non hypertensive patients who received coronary artery angiography. The patients with blood pressure≥ 140 /90mm Hg during the coronary angiography were divided into the observation group,while the patients with blood pressure 140 /90 mm Hg as control group. We measure the level of NO,the flow mediated dilation（ FMD）,the high sensitivety C react protein（ hsCRP） and the soluble CD40 ligand（ sCD40L）. Results The result of coronary angiography are mainly normal or with stenosis 50% in the control group while the stenosis 50% and ≥50% in the observation group mainly. The number of patients with stenosis ≥50% in the observation group（ n = 212） were higher than that of the control group（ n = 85）（ P 0. 05）,while the number patients with normal coronary artery angiography in control group（ n = 224） was significantly higher than that of the observation group（ n = 136）（ P 0. 05）. The level of NO [61. 7 mmol / L（ 39. 6- 82. 4） mmol / L〗 and the FMD [5. 8%（ 3. 7- 7. 1） %] in the observation group were lower than that of the control group [123. 6 mmol / L（ 82. 3- 164. 5） mmol / L; 11. 6%（ 7. 8-16. 5） %,P 0. 05]. The level of the hsCRP [8. 6 mg/L（ 5. 4-11. 8） mg/L],and sCD40L [17. 2 ng / ml（ 10. 6- 22. 3） ng / ml]were significantly higher than that of the control group [5. 3 mg / L（ 2. 9- 7. 1） mg /L; 7. 9 ng / ml（ 5. 1- 12. 2） ng / ml,P 0. 05]. Conclusions The degree of coronary artery stenosis in non hypertensive patients with elevated blood pressure during the coronary angiography is related to endothelial dysfunction and elevated inflammatory factor.