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目的 探讨血清高密度脂蛋白 胆固醇 (HDL C)水平与肱动脉内皮依赖性舒张功能之间的关系。方法 测定 71例血清总胆固醇水平相对正常的冠心病患者和 34例对照者的血脂水平以及在反应性充血时和含服硝酸甘油后肱动脉的内径变化。结果 冠心病组血流介导的肱动脉舒张和硝酸甘油所致的肱动脉舒张均低于对照组 [分别为 (2 6 1± 2 91) %比 (8 0 1± 4 72 ) %和 (17 2 2± 6 76 ) %比 (2 3 13± 8 6 1) % ,P均 <0 0 0 1]。多因素线性逐步回归分析显示 :血流介导的肱动脉舒张与血清HDL C水平呈正相关 (r=0 32 4,P =0 0 0 2 ) ,与血清总胆固醇、甘油三酯和低密度脂蛋白水平无关 ;硝酸甘油所致的肱动脉舒张也与上述血脂水平无关。根据血流介导的肱动脉舒张程度将两组受试者合并再分为A、B两组 ,A组肱动脉舒张≤ 4% ,B组肱动脉舒张 >4%。结果显示 ,A组HDL C水平明显低于B组 [(1 15± 0 2 6 )mmol/L对 (1 38± 0 5 0 )mmol/L ,P <0 0 1) ]。结论 冠心病患者内皮依赖性及非内皮依赖性的血管舒张功能均受损。HDL C对血管内皮依赖性舒张功能有保护作用 ,该作用可能与其抗动脉粥样硬化作用有关
Objective To explore the relationship between serum high density lipoprotein cholesterol (HDL C) and brachial artery endothelium-dependent relaxation. Methods Serum lipids were measured in 71 CHD patients with normal serum total cholesterol levels and 34 controls, and the changes of brachial artery diameter after reactive hyperemia and with nitroglycerin. Results Blood flow-mediated bradyarrhythmia and nitroglycerin-induced brachial artery vasodilation in CHD patients were significantly lower than those in the control subjects [(261 ± 2 91)% (801 ± 4 72)% and ( 17 2 2 ± 6 76)% (2 3 13 ± 8 6 1)%, all P <0 0 0 1]. Multifactorial linear stepwise regression analysis showed that blood flow-mediated brachial artery diastolic function was positively correlated with serum HDL-C level (r = 0 32 4, P = 0.00002), and serum total cholesterol, triglyceride and low density lipoprotein Protein levels; nitroglycerin-induced brachial artery diastolic blood lipid level has nothing to do with the above. According to the degree of diastolic blood flow-induced brachial artery, the two groups of subjects were combined and divided into A and B groups. In group A, the brachial artery relaxation was less than 4% and that of group B was more than 4%. The results showed that the level of HDL C in group A was significantly lower than that in group B [(1 15 ± 0 2 6) mmol / L vs (1 38 ± 0 0 0) mmol / L, P 0 01). Conclusion Endothelium-dependent and non-endothelium-dependent vasodilation were impaired in patients with coronary heart disease. HDL C has a protective effect on endothelium-dependent diastolic function, which may be related to its anti-atherosclerotic effect