冠状动脉介入治疗促进血管内皮素Ⅰ和血管紧张素Ⅱ的释放

目的 血管内皮损伤在经皮冠状动脉腔内成形(PTCA) 后的急性与慢性合并症的发生发展中起着重要的作用。本文探讨PTCA 术对血管损伤和缩血管物质的影响。方法 44 例单纯左冠状动脉前降支(LAD) 狭窄的患者, 被随即分配到单纯球囊扩张(BA) 组(11 例), 血管内放射治疗组(VBT, 14 例)及支架组(19 例)。于PTCA 术前及术后即刻, 术后4 h 和24 h 从冠状窦取血, 分别测定内皮素1(ET-1), 血管紧张素Ⅱ(ANG Ⅱ) 及vW 因子(vWF)。7例单纯行冠状动脉造影的患者作为对照组。结果 所有PTCA 患者术后即刻ET-1 水平显著增高, 而ANG Ⅱ及vWF 水平在PTCA 术后4 h 开始明显增高。BA 组、VBT 组及支架组间上述指标无明显差异。结论 冠状窦血中ET-1 及ANG Ⅱ、vWF 水平的改变反应了PTCA 术对血管损伤的程度。

Release of endothelin 1 and angiotensin II induced by percutaneous transluminal coronary angioplasty

Aim Endothelial dysfunction plays critical roles in acute and chronic complications after percutaneous transluminal coronary angioplasty (PTCA).Coronary endo thelial injury and the release of vasoactive substances induced by PTCA were investigated.Methods Forty-four patients with ischemic heart disease who underwent elective PTCA to isolated stenotic lesions in left coronary arteries were examined.Eleven patients received balloon angioplasty (BA), fourteen percutaneous int ravascular brachtheraphy (VBT), and nineteen stent implantation.Blood samples were drawn from the coronary sinus immediately before and 4 h and 24 h after PTCA.Levels of plasma endo thelin 1 (ET-1), angiotensin (ANG) Ⅱ, von Willebrand factor (vWF), and thrombomodulin (TM) were measured.Seven subjects who underwent diag nostic coronary angiopg raphy (CAG) were used as control group.Results In all patients, ET-1 levels in the coronary sinus blood significantly increased immediately after PTCA.ANG Ⅱ levels and vWF activity showed significantly increased immmediately 4 h after PTCA.Changes in levels of these markers were similar among the BA, VBT and stent groups.TM levels were elevated in all groups of patients, including those simply undergoing diag nostic CAG.Conclusion Changes in ET-1, ANG Ⅱ and vWF levels in the coronary sinus ref lect coronary endo thelial injury induced by PTCA.