乙酰胆碱诱发冠状动脉痉挛时的心电图改变及其与血管内皮功能关系

目的探讨血管内皮细胞功能紊乱与乙酰胆碱试验诱发冠状动脉痉挛时心电图ST段变化与缓慢型心律失常的关系。方法选择以静息性胸痛为主要临床表现、接受乙酰胆碱激发试验的患者为研究对象,根据是否发生冠状动脉痉挛分为阳性组和阴性组,冠状动脉痉挛发作时心电图变化分为ST段抬高和非ST段抬高组以及缓慢型心律失常和无缓慢型心律失常组,测定其血浆一氧化氮和内皮素1浓度,比较各组一氧化氮和内皮素1水平以及痉挛血管的分布。结果ST段抬高组一氧化氮水平显著低于阴性组,而内皮素1显著高于阴性组(P<0.01),非ST段抬高组一氧化氮水平亦显著低于阴性组,但高于ST段抬高组(P<0.05),而内皮素1显著高于阴性组但低于ST段抬高组(P<0.05);缓慢型心律失常组和无缓慢型心律失常组的血浆一氧化氮和内皮素1水平以及痉挛血管的分布差异无统计学意义(P>0.05)。结论乙酰胆碱试验诱发的冠状动脉痉挛以及ST段变化与血管内皮细胞功能紊乱有关,乙酰胆碱试验中的缓慢型心律失常与血管内皮细胞功能或痉挛血管的分布无关。

Relationship between changes of electrocardiogram and endothelial function in patients with coronary artery spasm induced by acetylcholine

Objectives: To explore the role of endothelial dysfunction in electrocardiographic changes of ST segment and bradycardia during coronary artery spasm provoked by acetylcholine. Methods: The patients with rest chest pain and underwent acetylcholine test were included and divided into spasm group (with provoked coronary artery spasm) and non-spasm group, ST elevation group (with ST segment elevation during coronary artery spasm) and non-ST elevation group, and bradycardia group (with bradycardia during coronary artery spasm) and non-bradycardia group. The levels of plasma NO and ET1 were measured by radioimmunoassay and Griess' assay respectively and compared between corresponding groups. The distribution of spastic coronary arteries was also compared between bradycardia group and non-bradycardia group. Results: The level of NO was significant lower but the level of ET1 was significant higher in ST elevation group than in non-spasm group (P<0.01) while these differences were remarkable but slighter between non-ST elevation group and non-spasm group (P<0.05) and between ST elevation group and non-ST elevation group (P<0.05). There was no significant difference in the levels of NO and ET1 as well as distribution of spastic coronary arteries between bardycardia group and non-bradycardia group (P>0.05). Conclusions: Coronary artery spasm and deviation of ST segment provoked by acetylcholine test were related to endothelial dysfunction. There was no relationship between bradycardia and endothelial dysfunction or distribution of spastic coronary arteries during acetylcholine test.