增强型体外反搏对不稳定型心绞痛患者血管内皮舒张功能及血浆脂蛋白磷脂酶A2水平的影响
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摘要
目的观察增强型体外反搏(EECP)对不稳定型心绞痛患者血浆脂蛋白磷脂酶A2(LP-PLA2)水平、血管内皮舒张功能的影响。方法选取来郑州大学第二附属医院就诊的100例已明确诊断的不稳定性心绞痛患者,随机分为常规药物治疗组(对照组n=49)和体外反搏组(观察组n=51,药物加体外反搏治疗,30 min/次,共30 d,总计60次)。入选对象均在入选当天及治疗结束当天检测血液中LP-PLA2水平,并用彩色多普勒超声检测肱动脉血流介导的血管舒张功能(FMD)及硝酸甘油片介导的血管内皮舒张功能(NMD)。结果观察组治疗后,LP-PLA2较治疗前下降,差异具有统计学意义(P <0.05),而FMD、NMD较治疗前均有升高,差异有统计学意义(P <0.05);对照组治疗后,LP-PLA2、内皮依赖型血管舒张功能及非内皮依赖型血管舒张功能较治疗前无明显变化(P> 0.05);组间观察发现,观察组FMD、NMD的提高程度较对照组明显(P <0.01),观察组的血浆LP-PLA2水平较对照组也有下降(P <0.01)。结论增强型体外反搏在血流切应力的作用下,可降低患者LP-PLA2水平,并改善血管内皮舒张功能。
Objective To investigate the effect of enhanced external counterpulsation(EECP) on plasma lipoprotein phospholipase A2(LP-PLA2) levels, vascular endothelial diastolic function in patients with unstable angina. Methods One hundred patients with unstable angina treated in our hospital were randomly divided into routine treatment group( control group n-49) and external counterpulsation group( observation group n = 51,routine treatment plus external counterpulsation therapy, 60 min/time, a total of 30 times). All selected subjects were tested for LP-PLA2 levels on the day of enrollment and on the 30 th day after treatment, and color Doppler ultrasonography was used to detect arterial blood flow-mediated vasodilation( FMD) and nitroglycerin-mediated vasodilation( NMD). Results After treatment in the observation group, LP-PLA2 decreased compared with before treatment, the difference was statistically significant(P < 0.05), but FMD, NMD were higher than those before treatment, which had statistical difference( P < 0.05). In control group treatment afterwards, LP-PLA2,endothelium-dependent vasodilatation and non-endothelium-dependent vasodilatation did not change significantly before treatment( P > 0.05). Observations between groups showed that the increase in FMD and NMD in the observation group was significantly greater than that in the control group. P < 0.01), plasma LP-PLA2 levels in the observation group also decreased compared with the control group(P < 0.05). Conclusion Enhanced external counterpulsation can reduce the level of LP-PLA2 in patients and improve endothelial diastolic function under the action of blood flow shear stress.
Objective To investigate the effect of enhanced external counterpulsation(EECP) on plasma lipoprotein phospholipase A2(LP-PLA2) levels, vascular endothelial diastolic function in patients with unstable angina. Methods One hundred patients with unstable angina treated in our hospital were randomly divided into routine treatment group( control group n-49) and external counterpulsation group( observation group n = 51,routine treatment plus external counterpulsation therapy, 60 min/time, a total of 30 times). All selected subjects were tested for LP-PLA2 levels on the day of enrollment and on the 30 th day after treatment, and color Doppler ultrasonography was used to detect arterial blood flow-mediated vasodilation( FMD) and nitroglycerin-mediated vasodilation( NMD). Results After treatment in the observation group, LP-PLA2 decreased compared with before treatment, the difference was statistically significant(P < 0.05), but FMD, NMD were higher than those before treatment, which had statistical difference( P < 0.05). In control group treatment afterwards, LP-PLA2,endothelium-dependent vasodilatation and non-endothelium-dependent vasodilatation did not change significantly before treatment( P > 0.05). Observations between groups showed that the increase in FMD and NMD in the observation group was significantly greater than that in the control group. P < 0.01), plasma LP-PLA2 levels in the observation group also decreased compared with the control group(P < 0.05). Conclusion Enhanced external counterpulsation can reduce the level of LP-PLA2 in patients and improve endothelial diastolic function under the action of blood flow shear stress.
引文
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[3]钟赟,叶飞.血清炎症因子水平与冠状动脉罪犯病变纤维脂质斑块纤维帽厚度的相关性研究[J].中华心血管病杂志,2017,45(7):566-571.
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[6]吕雪莹.血浆脂蛋白相关磷脂酶A-2在冠状动脉疾病中应用新进展[J].中国循环杂志,2017,32(2):190-193.
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[10]DUMITRESCU S I,CRISTIAN G,TINTOIU I,et al.Effect of blood pressure variability on endothelial function assessed by brachial artery flow mediated dilatation[J].Eur Heart J,2013,34(Suppl 1):5649.
[11]SHAKOURI S K,RAZAVI Z,ESLAMIAN F,et al.Effect of enhanced external counter pulsation and cardiac rehabilitation on quality of life,plasma nitric oxide,endothelin 1and high sensitive CRP in patients with coronary artery disease:apilot study[J].Ann Rehabil Med,2015,39(2):191-198.
[12]杨达雅,伍贵富.增强型体外反搏治疗冠心病的新机制--血流切应力效应[J].心血管病学进展,2013,34(4):456-459.
[13]LIANG M,XU S,LUO S,et al.Correlation between ambulatory blood pressure variability and vasodilator function in middleaged normotensive individuals[J].Blood Pressure Monit,2017,22(6):355.
[2]刘启云,刘莹莹,韩军丽,等.诊间血压变异性对老年高血压患者血管内皮功能的影响[J].南方医科大学学报,2015,35(9):1320-1324.
[3]钟赟,叶飞.血清炎症因子水平与冠状动脉罪犯病变纤维脂质斑块纤维帽厚度的相关性研究[J].中华心血管病杂志,2017,45(7):566-571.
[4]CHU X M,LI D,TIAN J,et al.GW28-e0922 The effects of EECP therapy on functions of endothelial progenitor cells and the restoration of endothelial function after emergency PCI of AMI[J].J Ame Coll Cardiol,2017,70(16):C100.
[5]贾张蓉,赵冬,齐玥,等.脂蛋白相关磷脂酶A2活性水平的性别差异及其与心血管病危险因素的关系[J].中华心血管病杂志,2013,41(11):962-967.
[6]吕雪莹.血浆脂蛋白相关磷脂酶A-2在冠状动脉疾病中应用新进展[J].中国循环杂志,2017,32(2):190-193.
[7]SEYFARTH J,REINEHR T,HOYER A,et al.Lipoprotein-associated phospholipase A2 activity in obese adolescents with and without type 2 diabetes[J].J Inherit Metab Dis,2017,41(8):1-7.
[8]PRASAD M,LENNON R,BARSNESS G W,et al.Chronic inhibition of lipoprotein-associated phospholipase A2 does not improve coronary endothelial function:A prospective,randomizedcontrolled trial[J].Int J Cardiol,2018,253:7.
[9]韩笑.原发性高血压患者血流介导的血管舒张功能与血压变异性的相关性[J].中华高血压杂志,2018,26(1):84-87.
[10]DUMITRESCU S I,CRISTIAN G,TINTOIU I,et al.Effect of blood pressure variability on endothelial function assessed by brachial artery flow mediated dilatation[J].Eur Heart J,2013,34(Suppl 1):5649.
[11]SHAKOURI S K,RAZAVI Z,ESLAMIAN F,et al.Effect of enhanced external counter pulsation and cardiac rehabilitation on quality of life,plasma nitric oxide,endothelin 1and high sensitive CRP in patients with coronary artery disease:apilot study[J].Ann Rehabil Med,2015,39(2):191-198.
[12]杨达雅,伍贵富.增强型体外反搏治疗冠心病的新机制--血流切应力效应[J].心血管病学进展,2013,34(4):456-459.
[13]LIANG M,XU S,LUO S,et al.Correlation between ambulatory blood pressure variability and vasodilator function in middleaged normotensive individuals[J].Blood Pressure Monit,2017,22(6):355.
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