解毒活血方对经皮冠状动脉介入术后患者NF-κB、IL-1β、TNF-α变化及支架内再狭窄的影响

Effect of Toxins-removing and Blood-activating Prescription on Changes of Nuclear Factor-kappaB,Interleukin-1β,Tumor Necrosis Factor-α and Incidence of In-stent Restenosis in PCI Postoperative Patients

【目的】观察解毒活血方干预经皮冠状动脉介入(PCI)术后患者外周血中核因子kappaB(NF-κB)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)的变化及支架内再狭窄(ISR)的发生情况,以期阐明解毒活血方防治ISR的远期疗效及机制。【方法】选择符合PCI术后纳入标准的患者40例,将PCI术后给予基础治疗者设为对照组,将PCI术后给予基础治疗+解毒活血方治疗者设为中药组,每组各20例。治疗结束后,观察2组临床疗效。于PCI术前及术后24 h、14 d,采用流式细胞仪检测2组患者外周血单个核细胞NF-κB活性,采用酶联免疫吸附法(ELISA)检测2组患者血浆IL-1β及TNF-α表达水平。观察患者术后6个月内心血管事件及ISR的发生情况。【结果】中药组患者的临床疗效显著优于对照组(P<0.05),证候积分及PCI术后6个月内心血管事件和ISR的发生率显著低于对照组(P<0.05或P<0.01)。2组患者PCI术后24 h NF-κB阳性表达率及TNF-α、IL-1β表达水平较治疗前显著升高(P<0.01),但2组差异无统计学意义(P>0.05);2组患者PCI术后14 d NF-κB阳性表达率及TNF-α、IL-1β表达水平较术后24 h显著降低(P<0.01),且中药组降低效果明显优于对照组(P<0.05)。【结论】解毒活血方可降低ISR的发生率,其机制可能与降低NF-κB活性及血浆IL-1β、TNF-α表达水平有关。

Objective To observe the changes of nuclear factor-kappaB（NF-κB）,interleukin-1β（IL-1β）,and tumor necrosis factor-α（TNF-α）in peripheral blood as well as the incidence of in-stent restenosis（ISR）in percutaneous coronary intervention（PCI）postoperative patients after treatment with Toxins-removing and Blood-activating Prescription（TBP）, so as to clarify the long-term therapeutic effect and mechanism of TBP for preventing and treating ISR. Methods Forty patients meeting PCI postoperative inclusion criteria were enrolled into the study. The post-PCI patients receiving basic treatment served as control group,and the patients receiving basic treatment plus TBP treatment served as Chinese medicine group,20 cases in each group. At the end of experiment,the therapeutic effects of both groups were observed. Before treatment, and 24 hours and 14 days after treatment,plasma IL-1β and TNF-α levels in the two groups were detected by enzyme-linked immunosorbent assay（ELISA）,and the activity of NF-κB in peripheral blood mononuclear cells of the two groups was measured by flow cytometry. The occurrence of cardiovascular events and the incidence of in-stent restenosis within 6months after PCI were observed. Results The clinical efficiency in Chinese medicine group was superier to that in the control group（P 0.05）. Syndrome scores,occurrence of cardiovascular events and incidence of ISR within6 months after PCI in the treatment group were significantly lower than those of the control group（P 0.05 or P 0.01）. NF-κB positive expression rate and IL-1β,TNF-α levels in the two groups 24 hours after PCI were higher than those of before PCI（P 0.01）,but the difference between the two groups was not significant（P 0.05）. NF-κB positive expression rate and IL-1β,TNF-α levels in the two groups 14 days after PCI were lower than those 24 hours after PCI（P 0.01）,and the decrease in Chinese medicine group was superior to that in the control group（P 0.05）. Conclusion TBP effectively reduces the incidence of ISR,and the mechanism is probably related with the down-regulation of NF-κB activity and plasma levels of IL-1β and TNF-α.