紫绀型先天性心脏病心肌侧枝血管形成机制的探讨

Study on the mechanism of formation of myocardial collateral vessels in cyanotic congenital heart disease

目的探讨紫绀型先天性心脏病心肌侧枝血管形成的机制。方法以22例紫绀型先天性心脏病(cyanoticcongenitalheartdisease,C鄄CHD)和24例非紫绀型先天性心脏病(acyanoticcongenitalheartdisease,A鄄CHD)患者为研究对象,取右心耳和血清为标本,采用双抗体夹心ELISA法测定术前、术后24h、术后72h血清VEGF(Vascularendothelialgrowthfactor)水平变化;并采用链霉菌抗生物素蛋白鄄过氧化酶免疫组化染色超敏法行心肌组织VEGF蛋白表达的测定,图像分析方法求出其PU(positiveunit)值。结果(1)术前血清VEGF表达C鄄CHD组明显比A鄄CHD组高(946.30±371.38vs289.00±32.18,P<0.001);(2)在C鄄CHD组,术后1天血清VEGF含量比术前显著降低(607.97±335.18vs946.30±371.38,P<0.001);(3)C鄄CHD组心肌VEGF表达显著高于A鄄CHD组(8.75±3.04vs4.55±2.06,P<0.001)。结论紫绀型先天性心脏病心肌侧枝血管形成可能为VEGF所介导。

Objective To explore the mechanism of the formation of myocardial collateral vessels in cyanotic congenital heart disease(C,CHD). Methods 22 cases with cyanotic congenital heart disease and 24 cases with acyanotic congenital heart disease (A,CHD) were studied retrospectively. Serum VEGF levels were measured with the Quantikine VEGF ELISA kits during preoperation,postoperative 24h and 72h.Myocardial VEGF levels were determined by immunohistochemical staining to VEGF with a modified avidin biotin,peroxidase method. Results (1) Preoperation: the serum VEGF levels in C,CHD group was higher than that of A,CHD (946.30 ± 371.83 vs 289.90 ± 32.18, P < 0.001). (2) In C,CHD group:the serum VEGF levels one day after postoperation decreased significantly than that preoperation(607.97±188.67 vs 946.30 ± 371.83,P < 0.001).(3)The Myocardial VEGF expression in C,CHD group was more than that of A,CHD group(8.75 ± 3.04 vs 4.55 ± 2.06,P < 0.001). Conclusion The VEGF may be mediate the collateral vessels formation in C,CHD.