激光心肌血管重建术后血管内皮细胞生长因子与碱性成纤维细胞生长因子的变化

Alteration of vascular endothelial growth factor and basic fibroblast growth factor post transmyocardial laser revascularization

目的：观察激光心肌血管重建术（ｔｒａｎｓｍｙｏｃａｒｄｉａｌｌａｓｅｒｒｅｖａｓｃｕｌａｒｉｚａｔｉｏｎ，ＴＭＲ） 后新生血管的变化及血管内皮生长因子（ｖａｓｃｕｌａｒ ｅｎｄｏｔｈｅｌｉａｌｇｒｏｗｔｈｆａｃｔｏｒ ，ＶＥＧＦ） 和碱性成纤维细胞生长因子（ｂａｓｉｃ ｆｉｂｒｏｂｌａｓｔ ｇｒｏｗｔｈ ｆａｃｔｏｒ ，ｂＦＧＦ） 在缺血心肌的表达。方法：制作大鼠急性心肌缺血模型，以单纯缺血为对照组，实验组行激光打孔。手术后６ 个不同时间点（３ 天、１ 周、２ 周、４ 周、６ 周、８ 周） 观察新生血管的变化情况并用免疫组化方法观察ＶＥＧＦ及ｂＦＧＦ的变化，并于显微镜下行计算机图像扫描计算光密度值。结果：实验组２ 周时可见新生的毛细血管，随时间推移逐渐增多。实验组孔道区在术后３ 天即有ＶＥＧＦ的表达，在４ 周时开始上升，ｂＦＧＦ在４ 周无明显表达，二者于６ 周时达高峰（０．０６２±０ ．００４ ｖｓ０．１９８ ±０ ．０２２ ， Ｐ＜ ０ ．００１；０ ．１１８ ±０ ．０１７ ｖｓ ０．２３３ ±０．０１２ ，Ｐ＜ ０ ．００１），８ 周开始下降。对照组仅于２ 周、４ 周有少量表达，于６ 周后逐渐消失。结论：ＴＭＲ 术可通过介导致血管生成的生长因子?

Objective: To observe the new vessel growth and the expression of vascular endothelial growth factor(VEGF) and basic fibroblast growth factor(bFGF) after transmyocardial laser revascularization(TMR) and to investigate the relationship between TMR, growth factor and angiogenesis. Methods:Preparation of acute myocardial ischemia rats, the control group is ischemia rats,the experiment group is ischemia and TMR rats. At six different time (3 days,1 week, 2 weeks,4 weeks,6 weeks,8 weeks),to observe the alteration of VEGF and bFGF by immunohistochemistry. Results: TMR group showed capillary growth beginning from week 2 and thereafter gradually increased till week 8. TMR group had significant higher VEGF expression than controls in all subgroups with a peak in week 6 postoperatively (0.062±0.004 vs 0.198±0.022, P <0.001). No significant differences in bFGF expression were found between two groups on day 3 and in week 1. It began to increase in week 2 in controls and reduced thereafter. In TMR group, it peaked in week 6. Level of bFGF were significant higher in TMR group compared with the control group in weeks 6 and 8 (0.118±0.017 vs 0.233±0.012, P <0.001; 0.113±0.034 vs 0.162±0.010, P <0.001). Conclusion: The expression of VEGF and bFGF was significantly increased after TMR procedure with vascular growth beginning in week 2 in the model of acute myocardial ischemia in rats. It appears that the angiogenic response was mediated by the release of certain angiogenic growth factors such as VEGF and bFGF. As the increasing recognition that the long term patency of myocardial channels created by laser does not exist, its mechanism may be related to the effect of angiogenesis.