水蛭和丹参对血管成形术后平滑肌细胞增殖影响的实验研究

Experimental Study of Hirudo and Salvia miltiorrhiza on Smooth Muscle Cell Hyperplasia after Balloon Angioplasty

目的 :探讨腔内血管成形术 (transluminalangioplasty ,TA)后再狭窄的预防方法。方法 :将 60支髂动脉 (3 0只家兔 )随机分为 3组 (每组 2 0支髂动脉 ) :水蛭组、丹参组和对照组 ,造成实验性动脉粥样硬化狭窄并进行TA后 ,水蛭组每天饲喂 2 g水蛭粉和普通饲料 ,丹参组每天饲喂 2 g丹参粉和普通饲料 ,对照组每天只饲喂普通饲料 ,3 0天后 ,进行血管造影和病理形态学检查。结果 :(1 )水蛭组髂动脉内膜厚度 (40 1± 9 8μm)显著小于丹参组 (48 2±8 2 μm)和对照组 (69 3± 9 2 μm) ,P <0 0 5。 (2 )TA后管腔狭窄度 ,水蛭组 (3 1 4% )和丹参组(48 4% )显著小于对照组 (62 8% ) ,P <0 0 5。 (3 )透射电镜观察表明 ,水蛭组和丹参组动脉内膜平滑肌细胞分化较好 ,细胞内粗面内质网较少 ,肌丝较多 ,而在对照组 ,平滑肌细胞内含有较多的粗面内质网 ,合成型平滑肌细胞较为多见。结论 :中药水蛭和丹参有抑制TA后血管平滑肌细胞增生 ,减轻内膜增厚 ,降低再狭窄发生率的作用 ,水蛭的效果更为显著。

Objective: To find the preventive method of restenosis after transluminal angioplasty (TA). Methods: Sixty rabbit iliac arteries of 30 rabbits were divided randomly into three groups, group A, B and C, 20 in each. After experimental atherosclerotic stenosis and TA performing, ordinary forage plus 2g of hirudo powder was fed to the group A every day, to the group B, 2 g Salvia miltiorrhiza powder was added and to the group C, ordinary forage only. Angiography and pathomorphological examination were carried out 30 days later. Results: (1)Hirudo significantly reduced the thickness of iliac intima as compared with the other two groups (P<0 05), the thickness in the group A, B and C was 40 1±9 8μm,48 2±8 2μm and 69 3±9 2μm respectively. (2)The incidence of restenosis after TA in both group A (31.4%) and group B (48.4%) were significantly lower than that in the group C(62.8%,P<0 05). And significant difference was also found in comparison of group A and group B (P<0 05).(3)Ultrastructure change examined by transmission electron microscopy showed that less rough endoplasmic reticulum and more myofilaments in well differentiated smooth muscle cell (SMC) of the arterial intima in the group A and B, while in the group C, more rough endoplasmic reticulum, more synthetic cells were seen in SMC. Conclusions: Hirudo and red sage root could effectively inhibit the hyperplasia of SMC in arterial intima and reduce the intima thickness and the incidence of restenosis after TA significantly, thus might play a role in the prevention of restenosis after TA. The effect of hirudo is more potent than that of red sage root.