CLINICAL VASCULAR BIOLOGY IN ATHEROSCLEROSIS

几项研究旨在调查改善 动脉粥样硬化患者的内皮功能障碍及其风险 因素 1)依那普利拉抑制血管紧张素转换酶（ACE） 急性改善冠状动脉内皮依赖性血管舒张， 动脉粥样硬化患者的外周血管及其风险 因素 这种改善是由于增加一氧化氮 ACE抑制剂的生物利用度。 目前的研究正在审查a） 血管紧张素II受体阻滞剂在观察到的改善中的作用 与ACE抑制剂，B）ACE抑制剂是否改善心肌 c）改善是否与ACE基因型有关。 2)谷氨酰胺改善内皮依赖性外周血管 动脉粥样硬化患者的血管扩张， 其次是增加一氧化氮的生物利用度。 3)多巴酚丁胺，一种β受体激动剂，用作正性肌力药， 心肌工作，扩张冠状血管，而运动 收缩冠状动脉，表明使用药物 压力可以掩盖冠状血管收缩， 冠状动脉粥样硬化患者的心肌缺血。 4)用于旁路手术的动脉导管（内乳 动脉）具有比隐静脉更高的一氧化氮活性 移植物和动脉粥样硬化冠状动脉，这可能解释了 动脉粥样硬化和血栓形成的发生率降低， 静脉导管

Several studies were designed to investigate strategies to improve endothelial dysfunction in patients with atherosclerosis and its risk factors. 1) Angiotensin converting enzyme (ACE) inhibition with enalaprilat acutely improved endothelium-dependent vasodilation in the coronary and peripheral vasculature of patients with atherosclerosis and its risk factors. This improvement was due to increased nitric oxide bioavailability with ACE inhibitors. Current studies are examining a) the role of angiotensin II receptor blockade in the improvement observed with ACE inhibitors, b) whether ACE inhibitors improve myocardial ischemia, c) whether the improvement relates to ACE genotype. 2) Glutathione improved endothelium-dependent peripheral vascular dilation in patients with atherosclerosis, a mechanism that was secondary to increased nitric oxide bioavailability. 3) Dobutamine, a beta receptor agonist used as an inotrope to increase myocardial work, dilates the coronary vasculature, whereas exercise constricts coronary arteries, indicating that use of pharmacologic stress can obscure coronary vasoconstriction that contributes to myocardial ischemia in patients with coronary atherosclerosis. 4) Arterial conduits used for bypass surgery (internal mammary arteries) have higher nitric oxide activity compared to saphenous vein grafts and atherosclerotic coronary arteries, which may account for the reduced incidence of atherosclerosis and thrombosis in arterial compared to venous conduits.