在冠状动脉移植术中他汀类药物应用于静脉移植后狭窄机制研究进展

Advances in the application of statins to stenosis after vein graft in coronary artery bypass graft surgery

相比于左侧乳内动脉及桡动脉,大隐静脉在冠状动脉移植后的长期通畅率较低。一系列的临床试验和观察研究表明他汀类药物在静脉移植通畅率治疗上有显著的益处。除了能降低血脂外,他汀类药物可以在移植静脉的血管壁上直接抑制甲羟戊酸途径发挥多效性,并且可以降低小GTP酶比如Rho和Rac的香叶酰化。他汀类药物能够改善内皮功能的同时减少血管炎性反应及氧化应激,并且抑制平滑肌细胞的增殖与迁移。为了能将这些机制安全地运用到临床实践中,更多的临床试验需要聚焦于他汀类药物对静脉移植通畅率的干预作用,文章将对上述问题做一综述。

Saphenous vein grafts used in coronary artery bypass graft surgery suffer from lower patency rates of long term compared with left internal mammary artery and radial artery.A number of clinical trials and observational studies have demonstrated a significant benefit of statin treatment on vein graft patency.Statins exert pleiotropic effects by direct inhibition of the mevalonate pathway in the wall of these grafts.This leads to reducing geranylgeranylation of small GTPases such as Rho and Rac.Through this LDL-independent mechanism,statins can improve endothelial function and reduce vascular inflammation and oxidative stress,and inhibit the proliferation and migration of smooth muscle cell.Although the existing evidence support a beneficial effect of statins on vein grafts biology,more clinical trials focused on the effect of aggressive statin treatment on vein graft patency are required,in order to safely translate this strategy into clinical practice.This article will make a discussion of the issues.