Molecular Biologic Approach of Coronary Circulation and Coronary Endothelial Function in Patients with Cyanotic Heart Disease

背景资料：以往的研究表明，在动物实验模型的设置中，急性缺氧可损害内皮功能。内皮源性一氧化氮和内皮素的释放是对由于红细胞增多症的高粘滞性引起的切应力增加的反应。在这方面，我们假设，血管内皮功能可能会受到损害，长期发绀或血流动力学应激的成人紫绀型心脏病患者。然而，对紫绀型心脏病成人患者的内皮功能知之甚少。目的：探讨紫绀型心脏病患者血管内皮功能及其相关因素。研究方法：对14例紫绀型心脏病患者（平均年龄：26.8±6.0岁，SaO 2：82.1±8.4%）和年龄匹配的对照组（平均年龄：30.9±8.3岁，SaO 2：98.1± 0.0%）进行了前臂血流（FBF）对握力运动或肱动脉闭塞的反应。 ...更多信息 9%）使用应变计体积描记法。作为血管内皮功能的相关因素，分析红细胞（RBC）、尿酸、MDA-LDL、ICAM-1、血管性血友病因子、血栓调节蛋白、内皮素、促红细胞生成素、尿8-羟基-2 '-脱氧鸟苷和尿NOx水平。结果如下：与对照组相比，紫绀患者的FBF对握力运动的百分比变化显著恶化（882.6±358.8% vs. 1428.41447.6%，p=0.007）。同样，紫绀患者肱动脉闭塞的FBF变化百分比显著低于对照组（292.6±89.9% vs. 455.6± 117.8%，p=0.002）。这种百分比变化与血氧饱和度、RBC和ICAM-1水平显著相关。结论：提示紫绀型心脏病患者存在血管内皮损伤，且与紫绀程度及血管内皮功能密切相关。剪应力。这种内皮功能受损可能会影响这些人群的长期结局。少

Background: Previous study demonstrated that endothelial function could be damaged by the acute hypoxia in the setting of the animal experimental model. Endothelial-derived nitric oxide and endothelial prostaglandins are released in response to the increase in shear stress due to hyperviscosity of erythrocytosis. In this regard, we hypothesized that vascular endothelial function may be damaged by long-standing cyanosis or hemodynamic stress in adult patients with cyanotic heart disease. However, little is known about endothelial function in adult patients with cyanotic heart disease. Objective: The purpose of this study was to evaluate the endothelial function and its related factors in adult patients with cyanotic heart disease. Methods: Forearm blood flow (FBF) response to handgrip exercise or brachial arterial occlusion were assessed in 14 patients with cyanotic heart disease (mean age: 26.8±6.0 years, SaO2: 82.1±8.4%) and age-matched control (mean age: 30.9±8.3 years, Sa02: 98.1±0. … More 9%) using strain gauge plethysmography. As the related factors of vascular endothelial function, red blood cell (RBC), uric acid, MDA-LDL, ICAM-1, von Willebrand factor, thrombomodulin, endothelin, erythropoietin, urine 8-hydroxy-2'-deoxyguanosine and urine NOx level were analyzed. Results: Percent change of FBF to handgrip exercise in cyanotic patients was significantly deteriorated than that in control (882.6±358.8% vs. 1428.41447.6%, p=0.007). Similarly, percent change of FBF to brachial arterial occlusion in cyanotic patients was significantly deteriorated than that in control (292.6±89.9% vs. 455.6±117.8%, p=0.002). Such percent changes were significantly correlated with oxygen saturation, RBC and ICAM-1 level. Conclusions: From these results, we concluded that vascular endothelial impairment exists in adult patients with cyanotic heart disease and closely related with severity of cyanosis or vascular. Shear stress. Such impaired endothelial function may influence on the long-term outcome in these populations. Less