【摘要】 目的 :探讨高三酰甘油 (TG)血症时血流动力学变化特点及其对血管内皮功能的影响机制。方法 :以 2 0例正常人、6 0例高TG血症患者 (其中 30例予以饮食治疗、30例予吉非罗齐治疗 )为观察对象 ,以肱动脉B超测量血管结构、血流和内皮依赖的舒张功能改变 ,并检测血浆一氧化氮 (NO)、氧化型低密度脂蛋白 (oxLDL)、血脂、血糖的变化。结果 :与正常对照组比较 ,除了常规血脂生化指标异常升高外 ,TG血症患者还有血oxLDL浓度升高、NO活性下降 ,且NO水平与TG、总胆固醇 (TC)、低密度脂蛋白胆固醇 (LDL C)和oxLDL浓度呈负相关。血管超声中心肌内温度、收缩期内径和舒张期内径差异无统计学意义 ,而平均血流速度 (Vm)、平均剪切率 (MSR)以及血流介导的扩张效应 (FMD)均显著减小 ,与NO水平呈正相关。 8周的低脂饮食治疗可使总胆固醇TC、TG水平下降 ,但NO、oxLDL和血管超声差异无统计学意义 ;吉非罗齐治疗组血TG、TC、LDL C和oxLDL浓度下降、NO浓度增高 ,血管超声FMD、Vm、MSR显著升高 ,而结构尚未见明显改变。结论 :高TG血症时TC、TG、LDL C水平和oxLDL共同参与了内皮的损伤机制 ,血流减缓、血流剪切率下降与NO活性的下降密切相关 ,临床表现为血管舒张功能的下降 ,调脂治疗有利于内皮舒张功能的改善。更多还原

【Abstract】 Objective:To investigate the impacts of hypertriglycerlipidemia on hemodynamics and vascular endothelial function.Method:Sixty hypertriglycerlipidemic patients were randomized into two groups(30 with low-fat diet treatment, 30 with gemfibrozil) compared with 20 normal controls. Vessel structure, hemodynamic index and endothelium-dependent vasodilation were assessed by B-mode ultrasound imager located in brachial artery. Serum NO, oxLDL, TC, TG, LDL-C, HDL-C, FBG, ALT and AST were measured.Result:Compared with controls, hypertriglycerlipidemic patients had higher level of oxLDL and lower level of NO,the last was inversely correlated with TG,TC, LDL-C, oxLDL. Hypertriglycerlipidemic patients had shown no significant difference in IMT?Ds and Dd, but lower Vm, MSR and FMD in dynamics index were correlated with NO. 8 weeks of low-fat diet could reduce TC and TG, but make no difference in NO, oxLDL and ultrasonic images. On the other hand, 8 weeks of gemfibrozil treatment not only reduced TG, TC, LDL-C and oxLDL, but also elevated NO, Vm, MSR resulted in increase of FMD.Conclusion:The endothelial impairment of hypertriglycerlipidemic patients might be caused by high level of TC,TG,LDL-C as well as oxidative substance such as oxLDL which could inactivate NO. The insufficiency of NO led by lower shear rate could result in descent of endothelium-dependent relaxation. Gemfibrozil treatment could improve endothelium-dependent relaxation.更多还原