冠心病患者介入治疗后血浆新型气体信号分子硫化氢及一氧化氮变化的临床研究

目的研究新型气体信号分子硫化氢（H2S）及一氧化氮（NO）在冠心病患者和冠脉造影正常者血浆中含量的差异及介入治疗对其的影响,探讨其在冠心病发病及介入治疗中的病理生理意义。方法冠心病组40例,造影正常组17例,采用硫敏感法测定术前血浆H2S含量并用Greiss法测定血浆中NO含量,动态监测冠心病患者冠状动脉造影前后、介入治疗后即刻、术后24h和72h血浆H2S、NO含量,分析冠心病组和造影正常组患者血浆H2S、NO含量的差异及介入治疗后血浆H2S和NO的变化。结果冠心病患者血浆H2S、NO含量远低于造影正常组（P均〈0.01）;冠脉双支和多支病变组血浆H2S含量差异无统计学意义（P〉0.05）,但均明显低于单支病变组（P〈0.05和P〈0.01）。不同支数病变冠心病患者血浆NO含量差异无统计学意义。冠脉血管有闭塞组其血浆H2S、NO含量明显低于单纯狭窄组（P均〈0.05）;支架植入术后复查狭窄者NO含量明显低于无狭窄者（P〈0.05）,H2S含量也低于无狭窄者,但差异无统计学意义（P〉0.05）。冠状动脉造影术对血浆H2S、NO含量无影响,但PCI治疗术后即刻H2S、NO含量显著降低;H2S含量术后24h恢复至术前水平,NO含量术后24h降至最低水平,72h仍未恢复至术前水平。结论 H2S和NO可能参与了冠心病的发病过程及介入治疗后急性血管闭塞及再狭窄的发生,血浆H2S含量的高低与冠脉血管病变严重程度相关。

Clinical study of the changes in new plasma gaseous transmitter H2S and NO in patients with coronary heart disease after percutaneous coronary intervention

Objective To investigate the changes of plasma H2S and NO levels in patients with coronary heart disease（CHD） after percutaneous coronary intervention.Methods The blood samples of 40 patients with coronary heart disease whoes coronary angiography indicated coronary stenosis and 17 healthy control subjects were obtained from the femoral artery immediately before and after angioplasty,immediately after PTCA and stenting,and were obtained from the peripheral vein at 24 h and 72 h after procedures.The levels of H2S and NO were measured by ion chromatography or gas chromatography.Results The plasma H2S and NO levels were significantly lowered in CHD patients in comparison with those in healthy control subjects（P〈0.01）.the plasma H2S level was significantly lower in CHD patients with double-vessel or multi-vessel lesions than that with single-vessel lesions（P〈0.01）,but there was no significantly difference between CHD patients with double-vessel and CHD patients with multi-vessel lesions（P〈0.05）.The plasma H2S and NO levels were significantly lower in CHD patients with coronary artery occlusion than those with simple stenosis subjects（P〈0.05）.The plasma H2S and NO levels were lower in CHD patients with restenosis than those with no-restenosis after stent planting,but there was no significant difference of the plasma H2S level between them（P〈0.05）.There were no changes before and after CAG,but the plasma H2S and NO levels were significantly decrease after PCI（P〈0.05）.And plasma H2S level returned to the baseline at 24 h after procedures,however,the plasma NO level didn＇t return to the baseline at 72 h after procedures.Conclusion H2S and NO might play a role in the pathophsiological process of CHD,acute occlusion and restenosis after percutaneous coronary intravention.And plasma H2S level showed a significant relation with pathological changes of coronary artery.