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目的对比观察冠心病患者外周动脉反应性充血指数(reactive hyperemia index,RHI)和循环内皮祖细胞(endothelial progenitor cells,EPCs)水平,探讨RHI在冠心病患者血管内皮功能评价中的应用价值,为冠心病病情评估、调脂治疗评价、预后评估提供临床手段。方法选取2015年9-12月在第三军医大学新桥医院全军心血管病研究所住院患者195例,其中男性115例,女性80例;平均年龄61岁,中位年龄60岁。根据冠状动脉造影结果分为冠心病组(129例)及对照组(66例)。冠心病组进一步按照心脏外科与介入治疗狭窄冠脉协同研究积分法(SYNTAX积分)分为低积分组、中积分组和高积分组。采用流式细胞术检测外周血中的EPCs,并使用外周血管内皮张力计Endo-PAT2000检测受试人群动脉RHI,比较RHI和EPCs评价冠心病危险因素的特异度和灵敏度。结果与对照组比较,冠心病组外周血中EPCs数量显著减少,RHI显著降低(P<0.05),外周血EPCs水平与动脉RHI呈显著正相关趋势(r=0.269,P<0.05)。各冠心病亚组中,中、高积分组较低积分组EPCs水平与RHI显著降低(P<0.05)。糖尿病、高血压病和吸烟可影响RHI和循环EPCs水平(P<0.05),糖尿病是影响RHI的主效应因素。结论 RHI因其操作便利、无创,可直观反映血管内皮功能以及可靠的灵敏度和准确性,在评价冠心病患者血管内皮功能方面较循环EPCs更有优势。
Objective To compare the levels of reactive hyperemia index (RHI) and circulating endothelial progenitor cells (EPCs) in patients with coronary heart disease (CHD) and evaluate the value of RHI in the evaluation of endothelial function in patients with coronary heart disease Cardiac disease assessment, lipid-lowering treatment evaluation, prognostic assessment provide clinical tools. Methods A total of 195 hospitalized patients at the Institute of Cardiovascular Research, Xinqiao Hospital, Third Military Medical University from September to December 2015 were selected, including 115 males and 80 females. The mean age was 61 years and the median age was 60 years. According to coronary angiography results were divided into coronary heart disease group (129 cases) and control group (66 cases). Coronary heart disease group was further divided into low-score group, middle-score group and high-score group according to SYNTAX score of cardiac surgery and interventional therapy. Peripheral blood EPCs were detected by flow cytometry. The peripheral arterial endothelial RHI was detected by Endo-PAT2000, and the specificity and sensitivity of RHI and EPCs in evaluating coronary heart disease risk factors were compared. Results Compared with the control group, the number of EPCs in peripheral blood of patients with coronary heart disease was significantly decreased, and the RHI was significantly lower (P <0.05). The level of EPCs in peripheral blood was positively correlated with RHI (r = 0.269, P <0.05). In each coronary heart disease subgroup, the levels of EPCs and RHI in the lower and middle integral groups were significantly lower (P <0.05). Diabetes mellitus, hypertension and smoking can affect the levels of RHI and circulating EPCs (P <0.05). Diabetes mellitus is the main effect factor of RHI. Conclusion Because of its convenient operation and noninvasive operation, RHI can directly reflect the function of vascular endothelium and its reliable sensitivity and accuracy. It is more advantageous than circulating EPCs in evaluating vascular endothelial function in patients with coronary heart disease.