血管腔内平整化治疗对动脉内膜剥脱术后内膜增生的影响及其机制

Effect of intravascular planarization therapy on intimal hyperplasia after artery endarterectomy in the animal model

目的探讨血管腔内平整化治疗(IPT)对内膜剥脱术后内膜增生的作用及其可能机制,为临床运用提供理论依据。方法用金钢砂磨针磨除内膜的方法建立颈动脉内膜剥脱模型。用随机数表法将新西兰兔随机分成两组(Ⅰ组比Ⅱ组),每组8只。Ⅰ组为颈动脉内膜剥脱模型对照组;Ⅱ组为采用金刚砂磨针磨除内膜后,行IPT;取对侧颈动脉作为自身对照。术后即刻及2周应用超声诊断仪评价血管狭窄程度。2周后,取两侧颈动脉标本行苏木精-伊红(HE)染色、Masson染色,评价内膜增生情况。采用t检验进行两组间比较,多组间比较采用单因素方差分析。结果2周后,Ⅱ组腔管比(内腔面积/总面积)低于Ⅰ组[(40.57±2.40)%比(52.79±2.01)%,t=8.387,P<0.01],新生内膜区Ⅰ型胶原蛋白表达低于Ⅰ组(0.134±0.020比0.110±0.011,t=2.621,P<0.05),血管平均血流速度低于Ⅰ组[(111.300±21.380)cm/s比(168.700±13.640)cm/s,t=4.222,P<0.01],管腔直径高于Ⅰ组(0.852±0.152)mm比(1.167±0.213)mm,t=2.529,P<0.05),差异均有统计学意义。结论IPT能够抑制动脉内膜剥脱术后内膜增生,可能与血小板黏附减少有关。

Objective To investigate the effects and mechanisms of intravascular planarization therapy(IPT)on intimal hyperplasia after artery endarterectomy.Methods An emery grinding needle was used to establish the model of artery endarterectomy.Totally 16 New Zealand rabbits were randomly divided into 2 groups(groupⅠand groupⅡ).In groupⅠ,rabbits were subjected to carotid endarterectomy alone.In groupⅡ,rabbits were given carotid endarterectomy and IPT.The normal opposite carotid artery served as controls in all rabbits.Ultrasound examination was performed to identify the degree of vascular stenosis immediately and at 2nd week after the surgery.Hematoxylin and eosin(HE)and Masson staining of carotid arteries was done to observe the pathological changes in the two groups at 2nd week after the surgery.Continuous variables were expressed as means±standard deviations and compared with Student′s t test or one-way ANOVA test.Results Lumen area/total area ratio[(40.57±2.40)%vs.(52.79±2.01)%,t=8.387,P<0.01],expression of typeⅠcollagen in neointima(0.134±0.020 vs.0.110±0.011,t=2.621,P<0.05),mean velocity[(168.700±13.640)cm/s vs.(111.300±21.380)cm/s,t=4.222,P<0.01],and lumen diameter[(0.852±0.152)mm vs.(1.167±0.213)mm,t=2.529,P<0.05]changed significantly in groupⅠas compared with groupⅡ,suggesting that IPT could reduce intima hyperplasia.Conclusion IPT could reduce intima hyperplasia due to decreased platelet adhesion.