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目的探讨无症状心肌缺血(SMI)的发生是否与炎症因子和内皮功能失调有密切的关系。方法对148例稳定性冠心病患者采用24h 动态心电图监测,分为 SMI 组和非 SMI 组。并行血脂、血糖、高敏 C 反应蛋白(hsCRP)等测定,高分辨率超声评估肱动脉内皮功能。结果 60例患者(40.5%)动态心电图记录 SMI,非 SMI 组与 SMI 组相比,hsCRP 浓度明显降低(0.9l±0.36:1.86±0.52,P<0.05),血流介导性舒张(FMD)功能有明显改善(3.02±1.46:6.36±3.79,P<0.05)。多因素分析发现 SMI 仅与 FMD(β=-0.452,P=0.046,OR=1.572)和 hsCRP(β=1.233,P=0.036,OR=1.632)有独立相关性。结论无症状冠心病患者仍有较高的 SMI 发生率;FMD、hsCRP 与 SMI 之间有较强的相关性,提示炎症和内皮功能失调可能是 SMI 发生的机制之一,hsCRP 和 FMD 有可能作为筛选 SMI 的替代指标。
Objective To investigate whether asymptomatic myocardial ischemia (SMI) is closely related to inflammatory factors and endothelial dysfunction. Methods 148 patients with stable coronary heart disease were monitored by Holter monitoring 24 hours and divided into SMI group and non-SMI group. Parallel blood lipids, blood glucose, high-sensitivity C-reactive protein (hsCRP) and other measurements, high resolution ultrasound assessment of brachial artery endothelial function. Results In 60 patients (40.5%), Holter recording recorded SMI. Compared with SMI group, the concentration of hsCRP in SMI group was significantly lower than that in SMI group (0.9l ± 0.36: 1.86 ± 0.52, P <0.05) Function was significantly improved (3.02 ± 1.46: 6.36 ± 3.79, P <0.05). Multivariate analysis showed that SMI was only associated with FMD (β = -0.452, P = 0.046, OR = 1.572) and hsCRP (β = 1.233, P = 0.036, OR = 1.632). Conclusion There is still a high incidence of SMI in patients with asymptomatic coronary heart disease; there is a strong correlation between FMD, hsCRP and SMI, suggesting that inflammation and endothelial dysfunction may be one of the mechanisms of SMI, hsCRP and FMD may be as Screening Alternatives to SMI.