血管支架置入术后细胞凋亡的实验研究  

Apoptosis after vascular stent implantation： experiment with rabbits

作　　者：卢勤[1] 朱光宇[1] 郭金和[1] 牛焕章[1] 安艳丽[1] 余辉[1] 魏晓莹[2] 滕皋军[1] 

机构地区：[1]东南大学附属中大医院放射科江苏省分子影像重点实验室,南京210009 [2]东南大学附属中大医院病理科,南京210009

出　　处：《中华医学杂志》2008年第16期1137-1141,共5页National Medical Journal of China

基　　金：国家自然科学基金资助项目（30300094）;江苏省自然科学基金资助项目（BK200507）

摘　　要：目的观察血管支架置放术后不同时间段血管壁增殖与细胞凋亡的变化过程。方法对16只家兔进行颈动脉内膜损伤及支架置放术。于术后即刻、7、14、28d，4个时间点处死。处死后取出支架部位及球囊损伤部位颈动脉血管段，进行细胞增殖与凋亡检测，包括电镜检查，病理切片HE染色及免疫组化分析细胞增殖核抗原（PCNA），Westem印迹检测凋亡相关基因p53、bcl-2。结果HE染色显示内膜损伤及支架置入血管在各时间点，血管壁全层均表现轻度不均匀增厚。PCNA在支架置入组与内膜损伤组都表现为术后即刻为阴性，术后7d为阳性表达，术后14d表达最强，术后28d表达为阴性；正常血管PCNA表达为阴性。电镜检查，内膜损伤及支架置放术都表现为较多胶原基质及纤维，细胞成分较多，可见含丰富分泌颗粒的细胞，可见吞噬细胞，术后28d标本可见凋亡的成纤维细胞。凋亡相关基因表达：p53，正常颈动脉组织可见p53表达；支架组术后即刻可见表达，术后7d表达减弱，术后14d表达可见，术后28d表达最强；内膜损伤组术后即刻、术后7d均较弱，术后14d表达稍有增加，术后28d表达最强；bcl-2，正常颈动脉组织未见表达；支架组术后即刻未见表达，术后7d表达增强，术后14d及术后28d未见表达；内膜损伤组术后即刻未见表达，术后7d表达增强，术后14d有微量表达，术后28d未见表达。结论血管支架置入术后可见异常的凋亡现象，术后早中期细胞增殖活性较高，后期出现细胞凋亡从而抑制细胞的增殖。Objective To investigate the dynamical procession of proliferation and apoptosis of cells in vascular wall after vascular stent implantation. Methods The femoral arteries of 16 rabbits were punctured. Balloon was inserted into the bilateral carotid arteries to cause injury of the tunica intima. A stent was implanted in unilateral carotid artery through the femoral artery and the opposite carotid artery was used as control. Four rabbits were sacrificed immediately, and 7, 14, and 28 days after operation respectively. Then the section of carotid artery where the tunica intima was injured and the stent was placed was resected and divided into 3 parts to undergo electron microscopy to observe cell proliferation and apoptosis, HE staining and immunohistochemistry to detect proliferating cell nuclear antigen （PCNA）, and Western blotting to detect the protein expression of the p53 and bcl-2, 2 apoptosis-related genes. Results HE staining showed irregular thickening of the vascular walls in both the injured and implanted carotid arteries. PCNA expression was negative immediately after operation, positive 7 days after operations, and strongly positive 14 days after operations, and then became negative 28 days after operation; PCNA expression was negative in the normal vascular walls. Electric microscopy showed that the injured intima and tissues where the stents were placed had much more extra matrix, collagenous fibers and lots of cells, some of the cells were rich in secretary granules, few phagocytes were seen, and apoptotic cells were seen in the samples 28 days after operations. Western blotting showed that protein expression of p53 was seen in the normal carotid tissues ; in the tissues of the stenting groups at a very low degree immediately after operation and then at a gradually increased degrees 14 and 28 days later; and the intimal injury group only showed a weak expression immediately and 7 days after operation, and a strong expression 14 days later. Bcl-2 expression was negative at any time points in the n

关 键 词：支架 血管 细胞凋亡 

分 类 号：R686[医药卫生—骨科学]