血清低密度脂蛋白胆固醇与组织6--K-PGF_(1α)变化对狗静脉移植物内膜增生的影响

Effects of Serum LDL ch and Luminal Surface 6 Keto Prostglandin F 1α on Intimal Hyperplasia of the Inferior Vena Cava Grafts.

目的探讨静脉重建通畅率的影响因素。方法用狗自体静脉碎片种植于涤纶（Ｄａｃｒｏｎ）、经全血预凝后间置植入下腔静脉（ＩＶＣ），（ｎ＝１３），用仅全血预凝的涤纶土植入ＩＶＣ作对照（ｎ＝８），对动物血清脂蛋白胆固醇含量、移植物内膜形态、厚度与腔面６－酮－前列腺素Ｆ１α（６－Ｋ－ＰＧＦ１α）量进行测定或观察。结果种植组通畅率（６１．５％）高于对照组（２５％），涤纶腔面术后２周完全被内皮细胞覆盖，通畅组移植物内膜厚度均值小于阻塞组，种植组小于对照组，与组织６－Ｋ－ＰＧＦ１α高于而血清总胆固醇（ＴＣ）及低密度脂蛋白胆固酮（ＬＤＬ－ｃｈ）低于阻塞组或对照组一致。结论内皮层不完善及由此所致６－Ｋ－ＰＧＦ１α减少可能是静脉系移植物内膜增生及远期通畅率低的原因之一，高ＴＣ与高ＬＤＬ－ｃｈ血症可能是促内膜增生的重要因素。

Objective To study effects of serum LDL ch and luminal surface 6 keto prostglandin F 1α (6 K PGF 1α ) on intimal hyperplasia of the inferior vena cava (IVC) grafts. Methods The Dacron grafts seeded with autologous venous fragments were implanted into IVC of the 13 dogs as seeded group and the control grafts, which were only preclotted with fresh blood, into 8 IVC. The levels of serum TC, LDL ch, HDL ch and luminal surface 6 K PGF 1α were measured at different times. All of the specimens explanted at exsaguination were observed with light microscopy and SEM and the thickness of the endothelium in grafts were measured too. Results New endothelial lining possible at two weeks after implantation of the seeded grafts, and the total patency rate were 61.5% in seeded group, but 25.0% in control one. The levels of serum TC and LDL ch were higher in occluded group or control group than that in the patent or seeded one at execution. This was in accordance with the results that the levels of luminal surface 6 K PGF 1α was lower and the endothelium was thicker in the occluded grafts in the seeded or control group than that of the patent one in the two groups. Changes of HDL ch were not statistically different from each other at any time.Conclusion The uncomplete endothelial lining with lower tissue 6 K PGF 1α levels may be one of the main causes resulting in intimal hyperplasia of the grafts, TC, LDL ch may improve hyperplasia on the luminal surface of the grafts. Endothelialization of prostheses, use of antiplatelet drugs and cholesterol lowering therapy may improve the graft patency of the vein reconstructions.