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目的:观察冠状动脉支架置入术(CSI)对急性冠状动脉综合征(ACS)患者血浆非对称性二甲基精氨酸(ADMA)水平的影响。方法:入选ACS患者(ACS组)81例(包括急性心肌梗死30例,不稳定型心绞痛51例),其中仅行药物治疗30例(非CSI亚组);行急诊CSI治疗51例(CSI亚组);另选取经冠状动脉造影排除ACS的人群54例作为对照组。采用高效液相色谱法测定冠状动脉治疗(造影)前,后1 h、1周、1个月时血浆ADMA水平,比较各组患者不同时期血浆ADMA水平的变化。结果:①ACS组血浆ADMA水平显著高于对照组(P<0.05);②CSI亚组患者血浆ADMA水平迅速且持续的降低(F=11.8,P<0.0001);非CSI亚组血浆ADMA水平缓慢下降(F=16.3,P=0.000);③对照组在冠状动脉造影后血浆ADMA水平升高,但总体水平低于ACS患者(F=7.4,P=0.000)。结论:CSI不仅不会使血浆ADMA水平增加,还能进一步降低其水平,其影响血浆AD-MA水平的机制与单纯冠状动脉造影对血浆ADMA水平的影响机制可能不同。
Objective: To investigate the effect of coronary stenting (CSI) on the plasma asymmetric dimethylarginine (ADMA) level in patients with acute coronary syndrome (ACS). METHODS: Totally 81 ACS patients (including 30 AMI patients and 51 unstable angina pectoris patients) were enrolled in this study. Only 30 patients (non-CSI subgroup) Group). Another 54 patients who underwent coronary angiography to exclude ACS were selected as control group. The level of plasma ADMA before and after coronary angiography (angiography) at 1 h, 1 week and 1 month after coronary artery surgery was measured by high performance liquid chromatography (HPLC). The changes of plasma ADMA levels in different periods were compared. Results: ①The level of plasma ADMA in ACS group was significantly higher than that in control group (P <0.05); ② The level of plasma ADMA in CSI subgroup was decreased rapidly and persistently (F = 11.8, P <0.0001) F = 16.3, P = 0.000). The level of ADMA in the control group after coronary angiography was higher than that in ACS patients (F = 7.4, P = 0.000). Conclusion: CSI not only does not increase the level of plasma ADMA, but also further decreases the level of ADMA. The mechanism of plasma ADMA level may be different from that of coronary artery angiography alone.