外周血Toll样受体4及TNF-α与冠状动脉支架置入术后再狭窄的关系  

The relationship of peripheral blood toll like receptor 4 and TNF-α with coronary in-stent restenosis

作　　者：马克娟[1,2] 郝蓬[1,2] 方冬平[1,2] 何东方[1,2] 赵林[1,2] 卢春山[1,2] 张英川[1,2] 郭成军[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所心内21病房,100029

出　　处：《心肺血管病杂志》2014年第5期678-682,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金青年项目(81200140)

摘　　要：目的：支架术后再狭窄（in-stent restenosis,ISR）是影响冠状动脉介入疗效的主要问题,本研究探讨外周血Toll样受体4（toll like receptor4,TLR4）及TNF-α与冠状动脉支架置入术后再狭窄的相关性。方法：入选135例稳定型心绞痛患者,冠状动脉造影示单支血管病变,并成功置入支架,术后6-12个月复查冠状动脉造影,将患者分为支架术后再狭窄组和无再狭窄组,采用流式细胞技术测定支架置入术前及术后5-7d外周血单核细胞TLR4的表达量,同时用酶联免疫吸附试验法（ELISA）检测血清中TNF-α的浓度。结果：复查冠状动脉造影发现14例患者发生支架内再狭窄,占10.4%,无再狭窄组121例,占89.6%。组间比较：术前TLR4及TNF-α的表达水平在两组间差异无统计学意义。分别为：TLR4[（144.20±52.99）vs.（117.40±61.9）,P〉0.05],TNF-α[（34.32±11.97）vs.（27.47±14.47）ng/L;P〉0.05];术后5-7d两组患者TLR4与TNF-α表达均升高,且再狭窄组升高更明显：TLR4[（182.20±61.59）vs.（125.10±61.9）,P〈0.01],TNF-α（52.62±19.04）vs.（32.63±13.71）ng/L,P〈0.01）。再狭窄组术后TLR4和TNF-α均升高,与支架置入术前相比差异有统计学意义;术后血清中TNF-α的浓度与外周血单核细胞中TLR4表达的平均荧光强度呈正相关。结论：冠状动脉支架置入术后外周血TLR4及TNF-α的表达均升高,且再狭窄组升高更明显,与无再狭窄组比较,差异有统计学意义。推测TLR4及TNF-α介导的炎症反应与支架术后再狭窄相关。Objective：In-stent restenosis（ ISR） is one of the major limitations of percutaneous coronary intervention（ PCI）. Here,our aim is to investigate the relationship of peripheral blood toll like receptor 4（ TLR4） and TNF-α with in-stent restenosis after coronary stent implantation. Methods： The study population consisted of 135 patients assessed by coronary angiography with single-vessel disease and underwent stent implantation into narrowed coronary segments. Patients were divided into 2 groups according to the angiographic study after 6 to 12 months follow-up： those with coronary in-stent restenosis and those without coronary in-stent restenosis. In addition,the evaluation of TLR4 level by flow cytometry and TNF-α level by ELISA method before PCI and 5-7 days after PCI was performed. Results： 14 patients（ 10. 4%） developed in-stent restenosis after 6-12 months follow up and 121（ 89. 6%） without ISR. There was no difference of the level of TLR4 and TNF-α before PCI between patients with and without ISR [TLR4：（ 144. 20 ± 52. 99） vs.（ 117. 40 ± 61. 9）,P〈0.05]; TNF-α： [（ 34. 32 ± 11. 97） vs.（ 27. 47 ± 14. 47） ng /L,P〈0.05）. Patients with ISR were characterized by significantly higher surface expression of TLR4 and serum concentration of TNF-α after PCI [TLR4：（ 182.20 ±61.59）; TNF-α：（ 52.62 ±19.04） ng/L） than patients without ISR,TLR4：（ 125.10 ±61.9）;TNF-α：（ 32. 63 ± 13. 71） ng /L,P〈0.01]. TLR4 expression correlated positively with plasma TNF-α level in patients with ISR after PCI. Conclusion： We demonstrate that elevated TLR4 and TNF-α after PCI are associated with coronary in-stent restenosis.

关 键 词：TOLL样受体4 TNF-Α 冠心病 经皮冠状动脉介入治疗 支架置入术后再狭窄 

分 类 号：R54[医药卫生—心血管疾病]