经皮腔内冠状动脉成形术及即刻支架植入术对内皮素和丙二醛的影响

Effects of percutaneous transluminal coronary angioplasty and immediate stent implantation on plasma endothelin 1 and malonaldehyole levels

目的 :研究经皮腔内冠状动脉成形术 ( PTCA)及即刻支架植入术 ( PTCA& S)对冠心病患者血浆内皮素 ( ET)和丙二醛 ( MDA)水平的影响。方法 :2 0例冠心病患者行 PTCA& S术 ,分别于 PTCA前 ,PTCA后 5 min,支架后即刻 ( 0 min)、5 m in和 10 m in同时采集冠状静脉窦 ( Cs)及外周静脉 ( Pv)血 ,于术后 12 h、1d、3d、7d继续采集外周静脉血 ,测定 ET- 1和 MDA水平。结果 :Cs中 ET- 1水平于 PTCA后 5 m in升高 ( P <0 .0 5 ) ,支架后即刻达到峰值 ( P <0 .0 1) ,Pv中 ET- 1水平在支架后即刻和术后 12 h呈现大小两个高峰 ( P <0 .0 1和 P <0 .0 5 ) ;Cs中 MDA水平在 PTCA后 5 min即有升高 ( P <0 .0 5 ) ,支架后 5 m in达峰值 ( P <0 .0 1) ,Pv中在支架后 5 m in升高 ( P <0 .0 5 ) ,支架后 10 min达峰值 ( P <0 .0 1)。结论 :PTCA& S术后 ET- 1呈两次释放 ,MDA水平的峰值时间较 ET- 1延迟 ,提示术后 ET- 1与活性氧介质相互促进 ,可能与术后血管痉挛。

Objective:To study the effects of percutaneous transluminal coronary angioplasty and immediate stent implantation (PTCA&S) on plasma endothelin 1 (ET 1) and malonaldehyole (MDA) concentrations in patients with coronary artery diseases (CAD). Method:20 patients with CAD underwent PTCA&S.ET 1 and MDA levels were measured at the paired sampling sites:the coronary sinus (Cs) and peripheral vein (Pv).The sampling blood in Cs was taken at the time before PTCA,5 min after PTCA,immediately and 5 min,10 min after the stent implantation.That in Pv taken till 12 h,1 d,3 d and 7 d after the implantation.Result:ET 1 level in Cs increased 5 min after PTCA (P< 0.05 ) and reached the peak immediately after stent implantation (P< 0.01 ),while in Pv ET 1 level exhibited two peaks immediately and 12 h after the implantation (P< 0.01 and P< 0.05 );MDA level in Cs reached the maximal value 5 min after the implantation (P< 0.01 ),while in Pv the peak time was delayed to 10 min after it (P< 0.01 ).Conclusion:ET 1 level exhibited two peaks after the stent implantation,and the peak level of MDA was behind that of ET 1.It was suggested that ET 1 and reactive oxygen intermediates promoted each other,which might have close relation with the vasospasm,thrombosis and myocardial stunning.