目的探讨冠状动脉高度狭窄老年冠心病患者冠状动脉侧支循环（CCC）的形成与血管活性物质血管紧张素转换酶（ACE）、血管紧张素Ⅱ（AngⅡ）、醛固酮（ALD），内皮素（ET）和一氧化氮（NO）之间的关系。方法收集成都军区昆明总医院2007年6月至2009年1月行冠状动脉造影，三支主要冠状动脉中至少有一支狭窄程度在95%以上的80例老年冠心病患者，年龄（70.23±7.86）岁。根据侧支循环形成情况，分为2组：CCC形成良好组和CCC形成不良组，并同时测定2组血中以下血管活性物质的活性及浓度：ACE，Ang Ⅱ，ALD，ET和NO。结果 CCC形成不良组患者血中ACE活性[（38.07±6.25） vs （27.02±4.15）U/L]，AngⅡ浓度[（90.27±10.31） vs （70.13±7.30）ng/L]， ALD浓度[（170.75±23.46） vs （130.34±11.23）ng/L]，ET浓度[（74.78±7.35） vs （57.23±6.04）ng/L]明显高于CCC形成良好组（P＜0.05），而NO浓度则相反[（34.8±6.24） vs （49.34±6.67）μmol/L；P＜0.05]。结论冠状动脉高度狭窄病变的老年患者中ACE，AngⅡ，ALD和ET不利于CCC的形成，而NO有利于CCC的形成。%Objective To investigate the relationship of formation of coronary collateral circulation(CCC) with serum levels of vessel reactive substances in patients with severe coronary arteries stenosis (SCAS). Methods A total of 80 consecutive senile patients, aged (70.23±7.86) years, who received coronary arteriography and identified with at lease 1 out of 3 main coronary arteries with over 95%stenosis in our department from June 2007 to January 2009, were subjected in this study. They were categorized into 2 groups according to their grading of collateral vessels:well-developed CCC group and proorly-developed CCC group. Vessel reactive substances, such as angiotensin-converting enzyme (ACE), angiotensin Ⅱ (Ang Ⅱ), aldosterone (ALD), endothelin (ET), and nitric oxide (NO), were measured in these patients. Results The activities or serum levels of ACE [(38.07±6.25) vs (27.02±4.15)U/L], Ang Ⅱ[(90.27±10.31) vs (70.13±7.30)ng/L], ALD [(170.75±23.46) vs (130.34±11.23)ng/L], and ET [(74.78±7.35) vs (57.23±6.04)ng/L] were significantly stronger or higher in poorly-developed CCC group than in well-developed CCC group (P<0.05), while the level of NO was obviously lower in the poorly than the well-developed CCC group [(34.8±6.24) vs (49.34±6.67)μmol/L], P<0.05). Conclusion The stronger activity of ACE and the higher serum levels of Ang Ⅱ, ALD, and ET are against the development of CCC in SCAS patients, but the higher level of NO is beneficial in the process.
展开▼
