体外心脏震波治疗对冠心病患者血管再生相关细胞因子的影响

Effects of CSWT on the Angiogenesis Related Cytokine of CAD Patients

目的 探讨体外心脏震波治疗（cardiac shock wave therapy,CSWT）对冠心病（CAD）患者血管再生相关细胞因子的影响.方法 选取冠心病陈旧性心肌梗死（OMI）患者87例,采用随机对照单盲法,将患者分为震波组62例,男48例,女14例,年龄43～80 （67.03±8.57）岁,其中根据治疗方案不同分为常规震波组（A组,每缺血靶区予9点治疗）32例和扩大震波组（B组,每缺血靶区予25点治疗）30例.3个月为1个治疗周期,共9次震波治疗.对照组（C组）患者25例接受相同震波治疗程序但不予震波能量.采用ELISA法检测所有患者入选时（0月）、随访3个月、6个月、12个月时外周血内皮型一氧化氮合酶（eNOS）、碱性成纤维细胞生长因子（bFGF）、SDF-1（基质细胞衍生因子-1）及其受体CXCR4的水平.结果 随访中26例患者因CAD事件再次住院,A、B组和C组分别各7、5、14例,两种震波方案间再次住院率的差异无统计学意义（P＞0.05）,却均低于对照组（P＜0.05）.随访3个月、6个月、12个月时,A、B组血清eNOS、bFGF、SDF-1、CXCR4水平均较0个月时明显改善（P＜0.05）;且B组以上指标均较同期A组改善（P＜0.05）;随访中A、B组患者以上指标均分别较同期C组改善（P＜0.05）.结论 CSWT可促进CAD患者eNOS、bFGF、SDF-1及其受体CXCR4蛋白的高表达,是一种新型、无创的血管再生疗法.

Objective To explore the effects of cardiac shock weve therapy （CSWT） on the angiogenesis related cytokine of CAD patients.Methods A total of 87 patients with old myocardial infarction （OMI） were enrolled in this study.Sixty-two patients were assigned in the CSWT group by using randomized single-blind method,including 32 cases in the regular treatment group （Group A,9 spots treatment of each ischemia target region） and 30 cases in the expanding scope treatment group （Group B,25 spots treatment of each ischemia target region） according to different shock wave （SW） procedure.And 25 cases were selected as the control group （Group C,treated with the same procedure but without the shock wave energy）.In the course for 3 months,9 CSWT procedures were performed totally to all patients.Before the SW treatment （0 month） and the follow-up of 3 months,6 months,12 months,the serum samples of all patients were collected and stored in-80℃ freezer for analysis.ELISA method was used to measure the concentrations of eNOS,bFGF,SDF-1 and CXCR4,and then the level of the angiogenesis related cytokine was evaluated.Results During follow-up,26 patients suffered from rehospitalization due to myocardial ischemia related symptoms,including 7 in group A,5 in group B,and 14 in group C.There was no significance difference in the rehospitalization rate between groups A and B （P ＞ 0.05）,while the rehospitalization rates of groups A and B were lower than that of group C （P ＜ 0.05）.Follow-up to 3 months,6 months and 12 months,the serum concentrations of eNOS,bFGF,SDF-1 and CXCR4 of patients in groups A and B improved significantly compared with 0 month （P ＜ 0.05）.All indexes in group B improved significantly compared with the same period of group A （P ＜ 0.05）,and the all indexes in CSWT group at the follow-up of 3 months,6 months and 12 months improved significantly compared with group C in the same period （P ＜ 0.05） Conclusion CSWT can promote the expressions of eNOS,bFGF,SDF-1 and its receptor CXCR4.It is a new and non-invasive treatment for CAD by promoting myocardial angiogenesis.