深静脉血栓溶栓治疗后对大鼠循环内皮细胞及受损内皮结构功能的影响  

Effect of anticoagulation and thrombolysis on circulation endothelial cells and endothelial function after acute inferior vena cava thrombosis in rats

作　　者：杨冰[1] 赵庆华[2] 赵渝[3] 

机构地区：[1]重庆医科大学附属第一医院护理学院,400016 [2]重庆医科大学附属第一医院护理部,400016 [3]重庆医科大学附属第一医院血管外科,400016

出　　处：《中华医学杂志》2011年第35期2506-2510,共5页National Medical Journal of China

基　　金：重庆市卫生局医学科学技术研究项目（2008-2-60）

摘　　要：目的观察溶栓抗凝治疗大鼠下腔静脉血栓（DVT）形成后对循环内皮细胞及受损内皮结构功能的影响。方法Wistar大鼠165只，135只建立大鼠急性下腔静脉血栓模型后运用随机数字表随机分为肝素治疗A组、尿激酶治疗B组、联合治疗C组各45只；另30只为假手术组（sham，SH）。各组给药后分别于血栓形成后第1、3、7、14、28天获取目标血管，扫描电镜评估局部内皮细胞层的完整性以及力学测量管壁血栓附着力，术后28d测定血液中循环内皮细胞数量，循环内皮祖细胞（CEPC）的数量及黏附能力。结果栓后1、3d，B、C组血栓附着力分别较A组低（P〈0．01）；7d时C组血栓基本消融；28d时C组内皮损伤较A、B组轻（P〈0．05）而A、B、C、SH组循环内皮细胞数量[（6．3±2．2）×10^6、（4．76±3．1）×10^6、（1．9±0．8）×10^6、（0．91±0．3）×10^6]依次降低，（P值均〈0．01），差异有统计学意义；CEPC数量（18．9±5．33、37．4±6．0、55．4±8．0、64．1±3．2）与CEPC黏附能力（9．6±2．9、17．5±3．2、22．1±4．4、28．3±2．0）依次增高，（P值均〈0．01），差异有统计学意义。结论急性深静脉血栓形成可导致大鼠血管内皮细胞脱落受损，循环内皮细胞数量增加。早期溶栓抗凝联合治疗能使局部血栓基本消融，对血管内皮细胞具有直接保护作用，并可能通过提高CEPC数量及功能发挥对血管内皮细胞的修复能力。但在急性血栓形成早期，联合治疗使得残余附壁血栓黏附力相对较低。Objective To explore the functions and adhesive properties of circulating endothelial cells after acute thrombosis in rats. Methods The inferior caval venous thrombosis model were treated with heparin （ n = 45 ）, urokinase （ n = 45 ） and a combination of heparin and urokinase （ n = 45 ） respectively. The sham group was treated similarly （ n = 30）. The thrombosed caval veins were harvested at Days 1, 3, 7, 14 and 28 post-thrombosis. Structural integrity and intimal hyperplasia were observed by light microscope. Scanning electron microscopy was used to assess the damage of endothelial cells in inferior caval vein wall. The level of thrombotic adhesion was measured in different phases. At Day 28, endothelial cell layer was observed under scanning electron microscope. Measurements were taken for circulating endothelial cells count, CEPC （ circulating endothelial progenitor cell） count and CEPC adhesive capacity. Results The adhesion to caval vein wall was lower in groups B and C than that in group A at Day 3 post-thrombosis （ all P 〈 0.01 ）. The endothelial damage in group A was more serious than groups B and C at Day 7 （ P 〈 0. 05 ） . And the endothelial damage was less severe in group C at Day 28 （ P 〈 O. 05 ）. For the rats in A, B, C, SH groups, the numbers of circulating endothelial cell [ （6. 3 ±2.2） ×10^6, （4.76 ±3.1） ×10^6 , （1.9 ±0.8） ×10^6 , （0.91 ±0.3） ×10^6], CEPC count （18.9 ±5.33, 37.4 ±6.0, 55.4 ±8.0, 64.1 ±3.2） and CEPC adhesion（9.6 ± 2. 9, 17.5 ± 3.2, 22. 1 ± 4. 4, 28.3 ± 2. 0） increased successively. There was statistical significance. Conclusion A combination of heparin and urokinase for the treatment of acute inferior caval venous thrombosis may effectively maintain the endothelial integrity of vein wall and decrease the fibroblast proliferation of thrombosed vein. Adhesion to caval vein wall is relatively lower during an early post- thrombotic period.

关 键 词：深静脉血栓形成 抗凝 溶栓 内皮祖细胞 血管内皮 

分 类 号：R543.6[医药卫生—心血管疾病]