IFAO转流术后血浆ET-1,NO测定的临床意义

Clinical Significance of Post-Operative Plasma Endothelin-1 (ET-1) and Nitric Oxide (NO) Levels Determinations in Patients with Ilio-Femoral Arteriosclerosis Obliterans (IFAO) Post-operatively

目的 :探讨髂股动脉硬化闭塞症 (IFAO)人工血管转流术后血浆内皮素 - 1(ET - 1)、一氧化氮 (NO)水平的变化规律及其临床意义。方法 :选择 2 0例行主 -股动脉转流术的IFAO患者 ,分别于手术前、手术后 1、3、7、14天以及手术后 1个月、6个月和 12个月抽取空腹静脉血 5ml,制备血浆标本 ,分别利用放射免疫分析和Grisse方法测定血浆ET - 1、NO水平 ,同时观察肢体缺血性表现和相关影像学检查指标的变化 ,分析ET - 1、NO水平与临床治疗效果和并发症的关系。结果 :16例手术效果良好者 ,血浆ET - 1水平于术后 1天明显升高 ,术后 3天开始下降 ,于术后 14天恢复正常水平 ,而NO则呈相反变化曲线 ,亦于术后 14天恢复正常 ;4例术后血运得到改善者 ,术后 3个月后缺血症状加重 ,并逐渐发现吻合口高度狭窄或闭塞 ,其血浆ET - 1和NO水平术后 2周内得到改善 ,但后期再次出现高ET - 1血症和低NO血症。结论 :IFAO患者及术后再狭窄患者存在高ET - 1血症和低NO血症 ,其高ET - 1和低NO现象于术后 2周内随肢体血运的改善而纠正 ,但当吻合口狭窄时再次出现高ET - 1血症和低NO血症 ;围手术期动态观察血浆ET - 1和NO水平 ,有助于评价治疗效果、判断预后和预测吻合口再狭窄的发生。

Objective To investigate the rule and clinical significance of post-operative alterations of plasma ET-1 and NO levels in patients with ilio-femoral arteriosclerosis obliterans. Methods Plasma levels of ET-1 (with RIA) and NO (with Grisse method) were repeatedly measured in 20 patients with IFAO before operation and on the 1st, 3rd, 7th, 14th day and 1st, 6th, 12th month after operation. Levels in 20 controls were also determined. Results There was a transient rise of ET-1 level and fall of NO level in all the patients on 1st to 3rd day post-operatively. However, the levels approached those in the controls by the 14th day with correction of the origninal higher pre-operative ET-1 and lower No levels in the patients. In four patients, Stenosis of the anastomotic sites developed gradually after three months with returning of the ET-1 and NO levels to abnormal pre-operative value. Conclusion Failure of sustained normalization of the pre-operative high plasma ET-1 and low NO values in patients with IFAO after operation would indicate a patency problem of the graft. Post-operative monitoring of the plasma ET-1 and NO levels would be of prognostic value.