Microvascular Angina. The Possible Role of Inflammation, Uric Acid, and Endothelial Dysfunction
Microvascular Angina. The Possible Role of Inflammation, Uric Acid, and Endothelial Dysfunction
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DOI：
10.1536/ihj.50.407
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发表时间：
2009-07-01
影响因子：
1.5
通讯作者：
Ramadan, Mahmoud M.
中科院分区：
文献类型：
--
作者：
Sakr, Sherif A.;Abbas, Tarek M.;Ramadan, Mahmoud M.
微血管性心绞痛是一种以心绞痛样胸痛和冠状动脉造影正常为特征的疾病。内皮功能障碍和全身性炎症以及血清高敏C反应蛋白（hsCRP）水平升高在其发病机制中起作用。为探讨C反应蛋白（CRP）、肱动脉血流介导的扩张（FMD）与微血管性心绞痛的关系，选择21例胸痛发作的微血管性心绞痛患者（研究组）和10例无症状的正常人（对照组）。患者和对照组进行了彻底的临床检查，超声心动图，心电图，和肱FMD（使用外部肱超声）。所有受试者的血清hsCRP和尿酸水平均进行了评估。研究组的平均hsCRP水平显著高于对照组（11.5 ± 3.8 vs 3.34 ± 1.5 mg/L; P < 0.001）。与对照组相比，微血管性心绞痛患者的肱动脉FMD显示出显著的损害（0.16 +/- 0.06 vs 0.76 +/- 0.09 mm; P < 0.001）。总胆固醇明显高于（196.1 +/- 44.4 vs 159.8 +/- 14.5 mg/dL; P = 0.018）和甘油三酯水平（185.0 +/- 103.2 vs 113.0 +/- 17.6 mg/dL; P = 0.038）;但这两组之间的平均血清尿酸水平差异无统计学意义。肱动脉FMD与任何临床变量之间均无显著相关性（踝/肱指数除外）。微血管性心绞痛可能有炎症因素（反映为血清hsCRP水平升高），以及内皮功能障碍（反映为肱动脉FMD受损）;而血清尿酸可能与微血管性心绞痛无关。(Int Heart J 2009; 50：407-419）
Microvascular angina is a condition characterized by angina-like chest pain and normal coronary angiography. Endothelial dysfunction and systemic inflammation with elevated serum high-sensitive C-reactive protein (hsCRP) levels play a role in its pathogenesis. This study aimed to explore the possible relation between CRP, brachial flow-mediated dilatation (FMD), and microvascular angina.We included 21 patients with attacks of chest pain diagnosed as microvascular angina (study group) and 10 normal asymptomatic subjects (control group). Patients and controls were thoroughly examined clinically and by echocardiography, electrocardiography, and brachial FMD (using external brachial ultrasonography). Serum hsCRP and uric acid levels were assessed in all subjects.A significantly higher mean hsCRP level was found in the Study group compared to controls (11.5 +/- 3.8 versus 3.34 +/- 1.5 mg/L; P < 0.001). FMD of the brachial artery showed significant impairment in patients with microvascular angina compared to controls (0.16 +/- 0.06 versus 0.76 +/- 0.09 mm; P < 0.001). There were significantly higher total cholesterol (196.1 +/- 44.4 versus 159.8 +/- 14.5 mg/dL; P = 0.018) and triglyceride levels (185.0 +/- 103.2 versus 113.0 +/- 17.6 mg/dL; P = 0.038) in the patients compared to controls; but there was a statistically insignificant difference in mean serum uric acid levels between these two groups. There were no significant correlations between the brachial FMD and any of the clinical variables studied (apart from ankle/brachial index).Microvascular angina may have an inflammatory element (reflected as a higher serum hsCRP level), together with a contribution by endothelial dysfunction (reflected as impaired brachial artery FMD); while serum uric acid is possibly not associated with microvascular angina. (Int Heart J 2009; 50: 407-419)