ADM和ET-1在冠状动脉内皮损伤中的表达

①目的研究冠状动脉粥样硬化性心脏病(CHD)病人急慢性冠状动脉内皮损伤时肾上腺髓质素(ADM)、内皮素-1(ET-1)在不同易患因素累积、不同冠状动脉狭窄程度、不同内皮稳定状态以及急性内皮损伤(PTCA)时的水平变化,探讨血管活性物质与急慢性内皮损伤的关系及临床意义。②方法选择72例CHD病人作为慢性内皮损伤组,按冠心病易患因素分为A(0~1个因素)、B(2个因素)、C(≥3个因素)组;按病人临床表现分为稳定型心绞痛组(SAP)和不稳定型心绞痛(UAP)组;按冠状动脉狭窄程度分为轻度狭窄、中度狭窄和重度狭窄组。急性内皮损伤组为28例PTCA病人。两组均以冠状动脉造影者作为对照。用放射免疫法测定各组ADM、ET-1的含量。③结果除A组ADM值与正常对照组无差异外(t=1.051,P>0.05),研究组血浆ADM、ET-1含量均高于对照组(t=4.287~13.945,P<0.01)。研究组内ADM、ET-1在3组间均有显著意义(t=2.813~11.649,P<0.01)。随着冠状动脉狭窄程度加重,ADM、ET-1有增高趋势,中度狭窄和重度狭窄组与对照组比较有明显增高(t=2.627~10.098,P<0.01);轻、中、重度狭窄3组间比较差异有显著性(t=3.150~11.708,P<0.01)。SAP组ADM、ET-1与对照组比较无显著性差异(t=0.297、1.983,P>0.05),而UAP组显著高于SAP组和对照组(t=2.932~12.175,P<0.01)。PTCA急性损伤冠状动脉内皮后与治疗前比较血浆ADM、ET-1水平显著升高(t=3.48、11.17,P<0.01)。④结论CHD易患因素对内皮细胞慢性损伤有累积作用。血浆ADM、ET-1水平与冠状动脉狭窄程度有关,可以作为判断CHD病情及预后的参考指标。UAP病人血浆ADM、ET-1水平可以作为判定心绞痛稳定性的参考指标。PTCA造成冠状动脉内皮急性损伤,激活ADM、ET-1的内皮源性释放。保护CHD病人内皮功能,干预易患因素及内皮功能的改善治疗是防止介入术后再狭窄及慢性内皮损伤的重要环节及途径。

EXPRESSION OF ADM AND ET-1 IN INJURIES OF CORONARY ARTERY ENDOTHELIUM

Objective To study the changes of ADM and ET-1 in patients with different risk factors, different coronary artery stenosis, different endothelial stability and after PTCA, and to discuss the relationship between the clinical significance of the vasoactive peptides levels and endothelial injury. Methods Seventy-two CHD patients were divided into different groups as follows: Group A(0-1 factor), Group B(2 factors), and Group C (3 factors) according to the presence of risk factors; SAP group and UAP group by the clinical pictures of the patients; low-degree, moderate- degree and high-degree stenosis groups by the degree of coronary artery stenosis. Twenty-eight patients who received PTCA were compared with those who only received CAG. The plasma ADM and ET-1 were determined by radioimmunoassay before and after PTCA and CAG. Results The levels of plasma ADM and ET-1 increased significantly in groups A, B, and C (t=4.287-13.945,P<0.01) compared to the control group(D). There were significant differences of ADM and ET-1 among the A, B, C groups (t=2.813-11.649,P<0.01). There were positive correlations between the levels of ADM and ET-1 and the degree of coronary artery stenosis. ADM and ET-1 were significantly higher in the moderate-degree and high-degree groups compared to the control group (t=2.627-10.098,P<0.01). In stenosis subjects there were significant differences among the three groups (t=3.150-11.708,P<0.01). The levels of ADM and ET-1 in UAP group were significantly higher than SAP group and control group (t=2.932-12.175,P<0.01). But there were no differences between SAP and control group (t=0.297-1.983,P>0.05). The levels of ADM and ET-1 increased significantly after receiving PTCA (t=3.48,11.17;P<0.01). Conclusion The risk factors of chronic injury to the endothelia can be accumulated. The levels of ADM and ET-1 are correlated with the degree of vessel diseases. They could be used as markers for severity of coronary artery injuries. The levels of ADM and ET-1 could be used as the criteria to differentiate angina pectoris. PTCA stimulates the release of vasoactive peptide. Effective control of the risk factors and correction of the dysfunction of endothelium are important therapeutic steps and methods in preventing the restenosis and chronic injuries of coronary endothelium. The levels of ADM and ET-1, which are the markers for endothelial injury, are correlated.