CAJ | 학술논문

目的探讨冠状动脉高度狭窄老年冠心病患者冠状动脉侧支循环（CCC）的形成与血管活性物质血管紧张素转换酶（ACE）、血管紧张素Ⅱ（AngⅡ）、醛固酮（ALD），内皮素（ET）和一氧化氮（NO）之间的关系。方法收集成都军区昆明总医院2007年6月至2009年1月行冠状动脉造影，三支主要冠状动脉中至少有一支狭窄程度在95%以上的80例老年冠心病患者，年龄（70.23±7.86）岁。根据侧支循环形成情况，分为2组：CCC形成良好组和CCC形成不良组，并同时测定2组血中以下血管活性物质的活性及浓度：ACE，Ang Ⅱ，ALD，ET和NO。结果 CCC形成不良组患者血中ACE活性[（38.07±6.25） vs （27.02±4.15）U/L]，AngⅡ浓度[（90.27±10.31） vs （70.13±7.30）ng/L]， ALD浓度[（170.75±23.46） vs （130.34±11.23）ng/L]，ET浓度[（74.78±7.35） vs （57.23±6.04）ng/L]明显高于CCC形成良好组（P＜0.05），而NO浓度则相反[（34.8±6.24） vs （49.34±6.67）μmol/L；P＜0.05]。结论冠状动脉高度狭窄病变的老年患者中ACE，AngⅡ，ALD和ET不利于CCC的形成，而NO有利于CCC的形成。
목적탐토관상동맥고도협착노년관심병환자관상동맥측지순배（CCC）적형성여혈관활성물질혈관긴장소전환매（ACE）、혈관긴장소Ⅱ（AngⅡ）、철고동（ALD），내피소（ET）화일양화담（NO）지간적관계。방법수집성도군구곤명총의원2007년6월지2009년1월행관상동맥조영，삼지주요관상동맥중지소유일지협착정도재95%이상적80례노년관심병환자，년령（70.23±7.86）세。근거측지순배형성정황，분위2조：CCC형성량호조화CCC형성불량조，병동시측정2조혈중이하혈관활성물질적활성급농도：ACE，Ang Ⅱ，ALD，ET화NO。결과 CCC형성불량조환자혈중ACE활성[（38.07±6.25） vs （27.02±4.15）U/L]，AngⅡ농도[（90.27±10.31） vs （70.13±7.30）ng/L]， ALD농도[（170.75±23.46） vs （130.34±11.23）ng/L]，ET농도[（74.78±7.35） vs （57.23±6.04）ng/L]명현고우CCC형성량호조（P＜0.05），이NO농도칙상반[（34.8±6.24） vs （49.34±6.67）μmol/L；P＜0.05]。결론관상동맥고도협착병변적노년환자중ACE，AngⅡ，ALD화ET불리우CCC적형성，이NO유리우CCC적형성。
Objective To investigate the relationship of formation of coronary collateral circulation(CCC) with serum levels of vessel reactive substances in patients with severe coronary arteries stenosis (SCAS). Methods A total of 80 consecutive senile patients, aged (70.23±7.86) years, who received coronary arteriography and identified with at lease 1 out of 3 main coronary arteries with over 95%stenosis in our department from June 2007 to January 2009, were subjected in this study. They were categorized into 2 groups according to their grading of collateral vessels:well-developed CCC group and proorly-developed CCC group. Vessel reactive substances, such as angiotensin-converting enzyme (ACE), angiotensin Ⅱ (Ang Ⅱ), aldosterone (ALD), endothelin (ET), and nitric oxide (NO), were measured in these patients. Results The activities or serum levels of ACE [(38.07±6.25) vs (27.02±4.15)U/L], Ang Ⅱ[(90.27±10.31) vs (70.13±7.30)ng/L], ALD [(170.75±23.46) vs (130.34±11.23)ng/L], and ET [(74.78±7.35) vs (57.23±6.04)ng/L] were significantly stronger or higher in poorly-developed CCC group than in well-developed CCC group (P<0.05), while the level of NO was obviously lower in the poorly than the well-developed CCC group [(34.8±6.24) vs (49.34±6.67)μmol/L], P<0.05). Conclusion The stronger activity of ACE and the higher serum levels of Ang Ⅱ, ALD, and ET are against the development of CCC in SCAS patients, but the higher level of NO is beneficial in the process.