冠状动脉支架术中内皮素及血管紧张素Ⅱ的变化

Endothelin-1 and angiotensin-Ⅱ variation in the coronary circulation during angioplasty with stents implantation

目的 :探讨经皮腔内冠脉成形术 (PTCA)及支架术中血浆内皮素 (ET- 1)及血管紧张素 (AT )的变化。方法 :44例冠心病患者随机分成冠脉造影组 (10例 )和 PTCA加支架组 (34例 ) ,共植入支架 48个 ,分别于术前、术中及术后 2 4h内不同时间点采集冠状静脉窦血及股动脉血 ,采用放免法测定 ET- 1及 AT 的浓度。结果 :冠脉造影前后 ET- 1及 AT 无显著变化 (P>0 .0 5 ) ;PTCA及支架组在球囊预扩张即刻 ET- 1轻度增高 (P<0 .0 5 ) ,AT 显著增高 (P<0 .0 1) ;支架后即刻 ET- 1及 AT 明显降低 (P<0 .0 5 ) ;支架后 10 min ET- 1及 AT 又有回升。术后12 h出现外周血 ET- 1及 AT 的升高。结论 :冠脉造影对冠脉循环血管活性物质无显著影响 ;PTCA加支架术中存在血管活性物质的波动 ,支架植入后即刻 ,冠脉循环血中 ET- 1及 Ang- 的降低与支架植入后局部血流改善有关 ,ET- 1及 Ang-

AIM: Endothelin 1 (ET 1) and angiotensinⅡ(ATⅡ) are endothelium derived mediators with vasoconstrictive and mitogenic activity which stimulates vascular smooth muscle cell proliferation. The aim of this study was to evaluate ET 1 and ATⅡ production during percutaneous transluminal coronary angioplasty (PTCA) and elective stent implantation. METHODS: Ten patients underwent angiography and 34 patients with coronary heart disease underwent PTCA and stenting (48 stents were inplanted in 28 stenosis with left anterior descending coronary artery and 9 with circumflex artery lesion and 11 with right coronary artery). Blood samples were obtained from the coronary sinus immediately before and after angiography or in stent implantation,1 min after the last pre stent balloon dilation and 10 min after, blood samples were obtained from stenting. Meanwhile femoral artery immediately before and 10 min,6, 12, 24 h after stenting. Results At baseline, ET 1 and ATⅡ levels were higher in the coronary sinus than in femoral artery (ET 1:57.2±5.3 pg/ml vs 51.2±5.4 pg/ml, ATⅡ:52.97±4.97 pg/ml vs 49.98±5.84 pg/ml, P < 0.05). Following last pre inflation, ET 1 coronary sinus levels slightly increased with respect to the basal levels while ATⅡ significantly increased (72.87±4.99 pg/ml vs 52.97±4.47 pg/ml, P <0.01). Significant decrease of ET 1 and ATⅡlevels were detected after and ATⅡ levels were detected after stent deployment. There was a second increase of ET 1 and ATⅡ in femoral artery 12 h after procedures. CONCLUSION: The lesion by PTCA and stent implantation seems to produce most of ET 1 and ATⅡ circulating in the coronary tree. Despite our expectations, we did not detect any significant ET 1 and ATⅡ increase in coronary circulation immediately after stent deployment, but there was a delayed increase in femoral artery 12 h after this procedures.