吴志坚 唐晓明 钱学贤 刘映峰 靳亚非 刘磊 510280 广州，第一军医大学珠江医院心内科 中华内科杂志 1998 0 0 12


    关键词：精氨酸；冠状动脉疾病 期刊 zhnkzz 0 论 著 fur -->


    

【摘要 】 目的 研究口服L-精氨酸对冠心病患者肱动脉流量介导舒张功能(FMD)的改善作用。方法 采用随机、双盲、安慰剂对照、交叉试验设计，20例患者平均62.8±9.3岁，血压正常，冠状动脉造影证实存在冠状动脉疾病，分别口服L-精氨酸(6.7g，3/d)或安慰剂7天，间隔洗脱期7天；用高分辨率血管外超声测定治疗前后肱动脉FMD和舌下含服硝酸甘油(0.5mg)后肱动脉非内皮依赖性舒张，用高效液相(HPLC)测定治疗前后血浆L-精氨酸水平的变化。结果 口服L-精氨酸1周后，肱动脉FMD从1.94%±2.62%升高至6.15%±3.04%(配对t检验：t=4.40，P<0.001，20例)，血浆L-精氨酸水平从84.36±15.38μmol/L升高至143.56±22.93 μmol/L(t=10.50，P<0.001，20例)；安慰剂治疗前后肱动脉FMD和血浆L-精氨酸均无明显改变，试验过程中L-精氨酸和安慰剂治疗前后肱动脉对舌下含服硝酸甘油的舒张反应性均无明显改变。结论 短期口服L-精氨酸可明显改善冠心病患者肱动脉FMD，具有增强患者内皮功能的潜在临床意义。

Effects of oral L-argininesupplementation on improving brachial endothelia function in patients with coronary arterydisease Wu Zhijian, Tang Xiaoming,Qian Xuexian, et al. Department of Cardiology, Zhujiang Hospital, The First MilitaryUniversity, Guangzhou 510282

【Abstract 】 Objective Todetermine the effects of short-term oral supplementation with L-arginine, the substratefor endothelium-derived nitric oxide (EDNO) synthesis on improving brachial endothelialfunction in patients with coronary artery disease (CAD). Methods Twenty normotensive patients (male 12, female 8, aged 62.8±9.3years) with clinical evidence of myocardial ischemia and angiographically proven CAD wereassigned to a randomized double-blind placebo-controlled crossover study. Each patientreceived oral L-arginine (6.7 g×3/d×7d) or placebo, separated by a washout period of 7days. Brachial diameter was measured with high-resolution external vascular ultrasound atrest, during reactive hyperaemia after 5 minutes of upper arm blood pressure cuffocclusion, again at rest, and after sublingual nitroglycerin (NTG, 0.5 mg). The diameterwas also measured before treatment with oral L-arginine or placebo and 3 hours after thelast dose. Brachial endothelium-dependent dilation and endothelium-independent dilatationwere expressed as the changes of the brachial diameter in response to reactive hyperaemia(causing flow-mediated dilation, FMD) and sublingual NTG respectively. Plasma L-argininelevels at baseline and 2 hours after the last dose of oral L-arginine or placebo wereanalyzed with high-performance liquid chromatography (HPLC). Results After 7 days of oral L-arginine treatment, brachial FMD increasedform 1.94%±2.62% to 6.15%±3.04% (paired t test: t=4.40, P<0.001, n=20), and plasma L-arginine rose from 84.36±15.38 to 143.56±22.93 μmol/L(t=10.50, P<0.001, n=20). No significant changes of brachial FMD (1.96, 2.03 vs 2.27,2.52%, t=0.63, P=0.53, n=20) and plasma L-arginine (77.72±16.79 vs 80.47±13.86 μmol/L, t=0.82, P=0.42, n=20) were observed before and afterplacebo. There were no significant changes of brachial dilator responses to sublingualnitroglycerin throughout the study in both L-arginine and placebo groups. Conclusion These results provide evidence that short-term oral supplementationwith L-arginine may effectively inmprove brachial FMD and may have potential clinicalsignificance in restoring endothelial function in patients with angiographically provenCAD.

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