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관상동맥 질환 환자에서 관상동맥내 Acetycholine 유발검사의 임상적 의의에 관한 연구
강흥선(Heung Sun Kang),조정휘(Chung Whee Choue),김권삼(Kwon Sam Kim),김명식(Myung Shick Kim),송정상(Jeung Sang Song),배종화(Jong Hoa Bae) 대한내과학회 1992 대한내과학회지 Vol.43 No.2
N/A Backgroand: Coronary vasoconstriction plays an improtant role in the pathogenesis of coronary artery disease. It has been known that acetylcholine (Ach) dilate normal vessels by releasing an endothelium- derived relaxing factor (EDRF), but when the endothelium is removed or dysfunctional, the vasodilator response is replaced by vasoconstriction resulting from the direct effects of this agent on vascular smooth mulscle. Methods: To evaluate the effects of intracoronary injection of Ach, 42 patients (27 males, 15 females; age range, 32~70 years) who had a history of chest pain were studied by using biplane cineangiography. Twentytwo patients had angiographically normal coronary arteries (Group I) and 20 patients had significant coronary artery disease (Group II). Results: Coronary artery vasoconstriction was induced in 11 patients (50%) of Group I, and in 14 patients (70%) of Group II by intracoronary injection of Ach. The site of vasoconstiction induced by Ach was more frequent in right coronary artery (23 patients out of 25 patients) than in left coronary artery. The levels of plasma total cholesterol in the patients with coronary vasoconstriction (GroupIB: 191.8±23.9 mg/dl, GroupIIB: 208.6±34.2mg/dl) were higher than those who without coronary vasoconstriction (154.5±35.9 mg/ dl)(p?0.01). Conclusion: These results suggest that vasoconstriction of coronary artery are induced easily by intracoronary injection of Ach and more frequent observed in right coronary artery, Intracoronary injection of Ach may be helpful in the evaluation of the patients with atypical chest pain and in the early detection of the patients with coronary artery atherosclerosis
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