PATHOGENESIS AND PATHOPHYSIOLOGY OF EXPERIMENTAL CORONARY ARTERY SPASM

尽管变异型心绞痛患者存在冠状动脉痉挛，但其发病机制无论在临床观察还是在实验研究中都存在争议。本研究的目的是1）描述动脉粥样硬化动物冠状动脉痉挛的病理生理学特征，2）通过血管造影确定高胆固醇血症或内膜增厚（几何效应）对组胺诱导的冠状动脉痉挛的作用，3）阐明体外动脉过度收缩的机制，而不受神经、体液和血液动力学因素的影响。在麻醉条件下，Gottingen小型猪的左冠状动脉局部剥脱的球囊导管，除了5只猪的冠状动脉痉挛引起的冠状动脉内注射组胺没有剥脱（组1）。将31头猪分为两组，每组3个月;一组饲喂2%胆固醇饮食（第2组），一组饲喂常规饮食（第3组）。 ...更多信息 组胺诱导的痉挛部位冠状动脉管腔狭窄为75 <-！+>4，78 <-！+>第374章！第1、2和3组分别为4%。苯乙哌啶、吲哚美辛或硫代血栓烷<A_2>在组胺过敏部位不增加冠状动脉狭窄。剥脱后3个月血清胆固醇水平为222 &lt;-！+&gt; 27和55 &lt;-！+&gt;第2组和第3组分别为6 mg/dl（组间p&lt;0.01）。组胺引起的管腔缩小百分比与内膜增厚程度呈指数相关（r=0.92），但内膜增厚通过几何效应对冠状动脉狭窄的贡献很小，约为7%。分离心脏，用Krebs-Henseleit液灌流。在离体条件下，组胺可在体内引起冠状动脉痉挛的同一部位剂量依赖性地引起冠状动脉过度收缩。血管造影显示管腔缩小程度（%）与体内相似。因此，在哥廷根小型猪实验性冠状动脉痉挛中，内膜增厚的血管可能伴随着对自体类固醇的收缩特性的功能改变。少

Although coronary artery spasm has been documented in patients with variant angina pectoris, its pathogenesis or mechanism has been debated not only in clinical observations but also in experimental studies. The goal of this study was 1) to characterize the pathophysiology of coronary spasm in atherosclerotic animals, 2) to determine angiographically the role of hypercholesterolemia or intimal thickening (geometric effects) on histamine-induced coronary spasm and 3) to elucidate the mechanism of arterial hypercontraction in vitro without influences of neural, humoral and hemodynamic factors. Under anesthetized condition, the left coronary artery of Gottingen miniature pigs was denuded regionally by a balloon catheter except 5 pigs in which coronary spasm was provoked by an intracoronary administration of histamine without denudation (group 1). Thirty one pigs were allotted to two groups for 3 months; a group fed a 2% cholesterol diet (group 2) and a group fed a regular diet (group 3). … More Histamine-induced luminal narrowing of the coronary artery at the spastic site was 75 <-!+> 4, 78 <-!+> 3 and 74 <-!+> 4% in groups 1, 2 and 3 , respectively. Phenylephrine, indomethacin or thiothromboxane <A_2> did not enhance coronary narrowing at the site with histamine-hypersensitivity. The serum cholesterol level 3 months after denudation was 222 <-!+> 27 and 55 <-!+> 6mg/dl in groups 2 and 3, respectively (p<0.01 between groups). Percent luminal reduction produced by histamine was exponentially related to the degree of the intimal thickening (r=0.92), however, the contribution of the intimal thickening on coronary narrowing via geometric effect was small and was about 7 %. These hearts were isolated, and were perfused by Krebs-Henseleit solution. Coronary artery hyperconstriction was provoked in vitro by histamine dose-dependently at the same site of spasm in vivo. The degree of luminal reduction (%) was similar angiographically to that in vivo. Accordingly, the vessel with intimal thickening may accompany functional alterations of contractile properties to autacoids in an experimental coronary spasm of Gottingen miniature pigs. Less