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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 investigate the effects of percutaneous transluminal coronary intervention on adrenomedullin (ADM) and tumor necrosis factor-α (TNF-α) in coronary circulation. Methods 33 cases of coronary heart disease patients were immediately before coronary angiography, immediately after balloon dilatation (PTCA), immediately after stent implantation, coronary sinus blood was collected 10 min after the operation, while femoral artery blood was collected, and radioimmunoassay was used to determine ADM , TNF-α concentration. Results The levels of ADM and TNF-α did not change significantly before and after coronary angiography (P> 0.05). The levels of ADM and TNF-α in coronary sinus significantly increased immediately after PTCA (P <0.01) ); ADM decreased to preoperative level 10 min after operation. Conclusions Coronary angiography has no effect on vasoactive substances in coronary circulation. The increase of ADM and TNF-α in coronary circulation after PTCA and stenting may be related to the mechanical compression and stimulation on the wall of the balloon and the stent. Both may participate in the PTCA and stent after acute occlusion, restenosis regulation.