【摘要】 目的：研究心血管危险因素控制能否达标对急性冠状动脉综合征(ACS)患者心脑血管事件的发生及血管内皮功能的影响,并探讨其机制。方法：对冠状动脉直径狭窄大于50%的109例 ACS 患者给予随访治疗,按能否坚持达标分为达标组50例及未达标组59例,比较两组血脂、血压、内皮依赖性舒张功能(FMD)、一氧化氮、内皮素、总一氧化氮合酶、死亡、急性心肌梗死发生率、不稳定性心绞痛住院发生率等情况。结果：9个月时未达标组因心原性猝死1例。达标组与未达标组在12个月：因不稳定性心绞痛住院发生率、急性心肌梗死发生率、收缩压、舒张压、低密度脂蛋白胆固醇及血糖,均有显著性差异。两组治疗随访6个月及12个月与治疗前比较：FMD、一氧化氮升高,均有显著性差异(P＜0.05～0.001)。治疗随访6个月及12个月时达标组与未达标组相比,FMD、一氧化氮、一氧化氮/内皮素值均升高,均有显著性差异(P＜0.05～0.001)；治疗随访12个月时诱导型一氧化氮合酶(iNOS)达标组与未达标组比较升高,有极显著性差异(P＜0.001)。FMD 与低密度脂蛋白胆固醇呈负相关,直线回归方程为：B=15.2668-1.8065A。FMD 与 iNOS 呈正相关,直线回归方程为：B=8.1662+0.0889A。结论：严格控制冠心病的危险因素达到规定的标准,可明显减少12个月内急性心肌梗死发生率和因不稳定性心绞痛住院的发生率。改善患者血管内皮功能,与低密度脂蛋白胆固醇水平降低和一氧化氮合酶、一氧化氮/内皮素值升高有关。更多还原

【Abstract】 Objective:To investigate the influence of effectively controlling coronary risk factors on the prognosis and endothelial func- tion in acute coronary syndrome(ACS) patients. Methods:One hundred and twenty ACS patients were required to give up smoking,lower high blood pressure,control diabe- tes mellitus,regulate hyperglycemias and take regular exercise.Twelve months later,these patients were divided into two groups. The first group reached the standard and the second group did not.The blood lipid level,Flow-mediate dilation,nitrous oxide (NO),endothelin (ET),nitricoxide synthase,unstable angina pectoris (UAP) and acute myocardial infarction (AMI) were com- pared between two groups. Results:No significant association between the two groups before the trial.The incidence of unstable angina pectoris and acute myocardial infarction was higher in the second group(P＜0.05).Six and 12 months after the trial,the levels of Flow-mediate dila- tion,nitrous oxide,NO/ET and iNOS were increased and ET was decreased in the first group compared with the second group. Conclusion:Strictly controlling coronary risk factors can greatly reduce the incidence of unstable angina pectoris and acute myocardial infarction and significantly improve Flow-mediate dilation.The mechanism may be associate with the increased NOS and decreased low-density lipoprotein cholesterol level.更多还原