左旋精氨酸对静脉移植保护作用的综合研究

The Synthetic Study of L-arginine to Graft Vein Protection

目的:观察左旋精氨酸(L-Arg)对自体移植静脉内膜增生的影响,探讨其作用机制。方法:(1)动物实验:60只新西兰兔,随机分为左旋精氨酸实验组、生理盐水对照组。所有动物术日建立自体静脉旁路移植模型:于术后1、2、4、6周及8周取材,统计学分析各组间差异。(2)临床试验部分:将33例欲行非体外循环冠脉搭桥手术的患者随机分成两组,对照组给予常规血管保存液处理血管桥,观察组给予含L-Arg的血管保存液处理血管桥。结果:(1)移植4周后,各组静脉均有内膜及中膜较正常颈静脉明显增厚表现,左旋精氨酸组内膜及中膜增厚较对照组轻。两组静脉桥的管腔狭窄程度进行比较存在明显差异。(2)两组手术成功率无显著性差异(P>0.05)。观察组术后细胞间黏附分子-1(ICAM-1)、内皮素-1(ET-1)及血管细胞黏附分子-1(VCAM-1)水平均较术前有明显降低(P<0.05),且与对照组比较有统计学意义(P<0.05)。结论:(1)兔静脉移植至股动脉后内膜及中膜增厚。(2)左旋精氨酸联合降脂药物能抑制移植静脉内膜及中膜增生,减少静脉桥狭窄。(3)含有左旋精氨酸的血管保护液可一定程度上改善血管内皮细胞的功能,从而延缓血管硬化,并有效控制病情进展。

Objective： To observe the effect of L-arginine on the intimal hyperplasia of autografted vein and todiscuss mechanism.Meth ods：（1） Autogenous vein graftsmodelwas established in 60 rabbits.Animals received either simvastatin（10 mg/kg/day） and L-argi nine（100 mg/kg/day） were injeted into the ear veins.The control group given normal saline.（2） Thirty-three CAD patients undergo ing OPCAB were divided into groups treatment（n=16）and control（n=17）.The treatment group were given with graft-protecting liquid concluding L-Arginine but the control without L-Arginine.Compare two groups with the rate of surgery triumph.Results：（1） The stenosis of grafted veins： 4 weeks later,the jugular veins intima /media membrane of all the operative group swere significantly thicker than The normal control group.There were significant differences between every two group（P 0.05）.（2）The rate of surgery tri umph Conclusion have no significant difference（P0.05）,but ICAM-1,ET-1,VCAM-l levels were significant difference than before（P 0.05）,and significant difference than the control.Conclusion：（1） The intima /media membrane of hare’s external jugular vein has thick ened after grafting.（2） Simvastatin can lessen the thickness of arterialized veins intima /media membrane and lighten the stenosis of the bridging vein.（3） graft-protecting liquid concluding L-Arginine could improve endothelial function,put off the development of coro nary artery disease.