摘要
目的探讨经皮腔内冠脉介入术对冠脉循环中肾上腺髓质素(ADM)及肿瘤坏死因子α(TNF-α)水平的影响。方法33例冠心病患者分别于冠脉造影前后即刻、球囊扩张(PTCA)后即刻、支架置入后即刻、术后10 min采集冠状静脉窦血,同时采集股动脉血,采用放免法测定ADM、TNF-α浓度。结果冠脉造影前后ADM及TNF-α无明显变化(P>0.05);PTCA后即刻冠状窦内ADM和TNF-α明显升高(P<0.01);支架后即刻ADM有上升趋势(P>0.05);术后10 min ADM降至术前水平。结论冠脉造影对冠脉循环血管活性物质基本不影响;PTCA及支架术后冠脉循环中ADM和TNF-α升高,可能与球囊损伤内皮、支架对管壁的机械压迫及刺激有关,两者可能参与了PTCA及支架术后急性闭塞、再狭窄的调节。
Objective To evaluate the effect of percutaneous intervention (PCI) on coronary circulation levels of adrenome- dullin (ADM) and tumor necrosis factor α(TNF-α) in patients with coronary heart disease (CHD). Methods Thirty-three CHD patients underwent percutaneous transluminal coronary angioplasty (PTCA) and stenting (altogether 48 stents were implanted). Blood samples were collected from the coronary sinus and femoral artery at the time points of immediately before and after angioplasty, immediately after PTCA or stenting, 10 min after procedures, respectively. Results The ADM and TNF-αlevels in the coronary sinus varied little after coronary angiography, but were elevated markedly following PTCA from the basal levels of 36.3±1.3 pg/ml to 28.9±1.9 pg/ml (P<0.01) and from 11.10±0.46 ng/ml to 8.84±0.37 ng/ml (P<0.01), respectively. Further increases of ADM and TNF-αlevels were detected immediately after stent deployment. ADM recovered to basal levels 10 min after completion of the procedures, while TNF-αunderwent further increase. Before the procedure, ADM and TNF-αlevels were higher in the coronary sinus than in the femoral artery (28.9±1.9 pg/ml vs22.6±0.8 pg/ml, P<0.01; 8.84±0.37 ng/ml vs7. 56±0.23 ng/ml, P<0.01, respectively), and their levels in the femoral artery did not undergo significant changes in response to the operations. Conclusion The coronary circulation levels of ADM and TNF-αincrease after PTCA and stenting but not after coronary angiography in CHD patients, which might be attributed to injuries by the procedures as well as the mechanical stimulation by the stent.
出处
《第一军医大学学报》
CSCD
北大核心
2004年第6期636-638,645,共4页
Journal of First Military Medical University
基金
国家重点基础研究发展项目(973)子课题(G2000056905)~~
关键词
肾上腺髓质素
肿瘤坏死因子
经皮腔内冠脉介入术
球囊扩张
支架置人
冠脉循环
adrenomedullin
tumor necrosis factor
percutaneous intervention
percutaneous transluminal coronary angioplasty
stenting
coronary circulation
