【摘要】 目的探讨无症状心肌缺血(SMI)的发生是否与炎症因子和内皮功能失调有密切的关系。方法对148例稳定性冠心病患者采用24h 动态心电图监测,分为 SMI 组和非 SMI 组。并行血脂、血糖、高敏 C 反应蛋白(hsCRP)等测定,高分辨率超声评估肱动脉内皮功能。结果 60例患者(40.5%)动态心电图记录 SMI,非 SMI 组与 SMI 组相比,hsCRP 浓度明显降低(0.9l±0.36:1.86±0.52,P<0.05),血流介导性舒张(FMD)功能有明显改善(3.02±1.46:6.36±3.79,P<0.05)。多因素分析发现 SMI 仅与 FMD(β=-0.452,P=0.046,OR=1.572)和 hsCRP(β=1.233,P=0.036,OR=1.632)有独立相关性。结论无症状冠心病患者仍有较高的 SMI 发生率;FMD、hsCRP 与 SMI 之间有较强的相关性,提示炎症和内皮功能失调可能是 SMI 发生的机制之一,hsCRP 和 FMD 有可能作为筛选 SMI 的替代指标。更多还原

【Abstract】 Objective To explore the association between silent myocardial isehemia(SMI)and high sensitivity C-reactive protein(hsCRP)and endothelial dysfunction.Methods 148 asymptomatic patients(103 men and 45 women)with known CAD were recruited.According to the results of ambulatory electrocardiography recording(AECG),patients were divided into two groups:SMI group and non-SMI group.All the patients underwent assessment of endothelial dependent flow mediated dilation(FMD)with high resolution ultrasound for the evaluation of endothelial function and 24-hour three-lead ambulatory electrocardiography recording for the detection of SMI.Serum hsCRP,blood glucose,HDL cholesterol,LDL cholesterol and treglycerides were measured.Results Sixty of the 148 patients had SMI,with a relatively high prevalence of 40.5%.The serum concentration of hsCRP in SMI group was higher than that in non-SMI group(1.86±0.52 vs 0.91±0.36,P<0.05)and FMD was lower in SMI group than that in non-SMl group(3.02±1.46 vs 6.36±3.79,P<0.05).In logistic regression analysis,SMI was found to be related only to FMD(β=-0.452,P=0.046,OR=1.572)and hsCRP(13=1.233,P=0.036,OR=1.632). Conclusions SMI shows a relatively high prevalence in patients with known stable CAD;it is suggested that this population still needs to be carefully evaluated with risk stratification.SMI may be caused by inflammation and endothelial dysfunction.FMD and hsCRP may serve as the surrogate markers in screening SMI in patients with known CAD.更多还原