冠状动脉支架置入早期炎症及内膜增殖反应的指标变化

Early inflammation and intimal proliferation of coronary artery after coronary stent implantation

背景:支架置入后的损伤修复过程是多因素共同作用的结果。目的:观察冠状动脉支架置入后早期炎症、细胞增殖及凋亡指标变化。设计、时间及地点:非随机病例对照试验,2005-02/2007-02厦门中山医院心脏中心。对象:选择经冠状动脉造影检查证实为冠心病的患者,支架组30例及造影组30例。方法:术前,术后30min,1,3d分别采集肘静脉血,CD11b、FasL的水平采用流式细胞仪直接免疫荧光法检测。超敏C反应蛋白的水平采用免疫散射比浊法检测。血管紧张素Ⅱ的水平采用放射免疫分析法检测。主要观察指标:超敏C反应蛋白、CD11b、血管紧张素Ⅱ、FasL水平。结果:支架组中反映炎症状态的指标CD11b、超敏C反应蛋白在支架置入后30min高于置入前(P<0.01),并以置入后1d为高峰期;支架组反映内膜细胞增殖和凋亡的指标血管紧张素Ⅱ,FasL在支架置入后30min高于置入前(P<0.01)。其中血管紧张素Ⅱ于支架置入后持续增高,而FasL于支架置入后1d达到高峰。支架组置入后30min,1,3d各指标水平高于同期造影组(P<0.01)。结论:支架置入在早期即能够诱发明显的炎症反应,并能通过促使血管紧张素Ⅱ水平增高及Fas-FasL系统激活,使得支架置入后的内膜细胞增殖和凋亡在相当一段时间内维持于高水平。

BACKGROUND： Injury and reparative process following stem implantation are caused by multiple factors. OBJECTIVE： To observe early inflammatory reaction and proliferation and apoptosis after percutaneous transluminal coronary stent implantation. DESIGN, TIME AND SETTING： The non-randomized control experiment was performed at the Heart Center of Xiamen Zhonshan Hospital from February 2005 to February 2007. PARTICIPANTS： Patients who diagnosed as having coronary heart disease by coronary arteriography were involved and divided into two groups, as percutaneous coronary intervesion （PCI） group （30 patients） and coronary angiography （CAG） group （30 patients）. METHODS： Ulnar vein blood was collected at 30 minutes before and after surgery, 1 and 3 days after surgery. Flow-cytometry （direct immunofluorescence） was used to measure CD11b and FasL levels. High-sensitivity C reactive protein levels were determined by nephelometry. Angiotonin Ⅱ levels were determined by radioimmunoassay. MAIN OUTCOME MEASURES： High-sensitivity C reactive protein, CDllb, angiotonin Ⅱ andFasLlevels RESULTS： The levels of CD11b of leukocyte, high-sensitivity C reactive protein began to rise at half an hour after the operation （P 〈 0.01）, and reached the peak at 1 day after the operation in PCI group. The levels of angiotonin Ⅱ and Fas ligand of leukocytes at half an hour after operation was higher than those before operation （P 〈 0.01）. In PCI group the levels of angiotonin Ⅱ raised gradually after the operation and the level of Fas ligand reached the peak at 1 day after the operation. These levels were higher in the PCI group than in the CAG group at 30 minute, 1 and 3 days after implantation （P 〈 0.01）. CONCLUSION： PCI triggers inflammatory reaction at early period after percutaneous transluminal coronary stent implantation, and maintain intimal proliferation and apoptosis on a high level by increasing the levels of angiotonin Ⅱ and activating Fas/FasL system.