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Relationship between the endothelial glycocalyx and the extent of coronary atherosclerosis. OBJECTIVE: To investigate the correlation between the EG and the severity of coronary atherosclerosis. METHODS: A total of193 subjects were divided into two groups. A SDF video microscope with a glycocalyx thickness measurement system was used to visualize the sublingual microcirculation. The levels of HA in the peripheral circulation and coronary circulation were determined via enzyme-linked immunosorbent assay. The number of coronary artery lesions and the Gensini score were used to evaluate the severity of the coronary atherosclerosis. RESULTS: EG thickness in the coronary heart disease (CHD) group (242.18 ± 10.10 nm) was lower than that in the NON-CHD group (251.78 ± 10.59 nm, P < 0.001). There was a negative correlation between the EG thickness and the number of coronary lesions and the Gensini score. The level of intracoronary HA in the CHD group (48.60, 126.27) was higher than that in the NON-CHD group (20.60, 34.45, P < 0.001), and it was positively correlated with the number of coronary lesions and the Gensini score. CONCLUSIONS: EG damage was correlated with the occurrence and development of coronary atherosclerosis. The EG thickness in the capillaries of the oral submucosa and the intracoronary HA level can be used as auxiliary indexes to assess the severity of coronary atherosclerosis.