症状性大脑中动脉狭窄支架置入术后内皮修复功能的研究  

Endothelial repairing function in patients with symptomatic middle cerebral arterial stenosis after stent implantation

作　　者：苏江利[1] 薛新红[1] 亓立峰[1] 曲怀谦[1] 

机构地区：[1]山东省聊城市人民医院聊城市脑血管病介入中心,252000

出　　处：《中华全科医师杂志》2015年第3期185-189,共5页Chinese Journal of General Practitioners

基　　金：“十二五”国家科技支撑计划课题（2011BA108B02）

摘　　要：目的探讨症状性大脑中动脉狭窄经皮支架置入术的有效性和安全性，术后内皮修复功能与术后再狭窄情况。方法对2008年1月—2012年10月诊治的66例症状性大脑中动脉狭窄患者行支架置入术治疗，于术后1年根据头颈CT血管造影（CTA）检查结果分为再狭窄组（23例）和无狭窄组（43例），采用流式细胞仪检测血内皮祖细胞（EPCs）数量、黏附能力测定试验及Transwell实验检测EPCs黏附、迁移能力及血管内皮生长因子（VEGF）的水平，分析其与术后再狭窄的关系。结果66例大脑中动脉狭窄经皮血管内支架置入术均获成功。术后1年23例患者出现不同程度的再狭窄，其中14例再狭窄50％，14例中l例患者为大脑中动脉闭塞。再狭窄组患者较无狭窄组外周血中EPCs数[（33．7±4．6）比（61．6±6．4）个]、贴壁细胞数[（26．1±7．5）比（56．3±9．6）个]、迁移细胞数[（12．0±3．9）比（21．4±6．5）个]及VEGF水平[（56．7±14．6）比（89．6±17．3）ng／L]均明显降低，差异均有统计学意义（t值分别为18．48、13．09、6．34和7．73，均P〈0．01）。结论症状性大脑中动脉支架置入术安全、可行、有效。术后1年血管再狭窄者EPCs、VEGF水平及EPCs黏附、迁移能力下降明显，检测EPCs、VEGF水平有利于判断血管再狭窄的可能。Objective To investigate the relation between endothelial repairing function and in-stent restenosis in patients with symptomatic middle cerebral arterial （ MCA ） stenosis after stent implantation. Method Sixty-six patients with symptomatic MCA stenosis underwent percutaneous stcnt implantation. Cranial CTA revealed that 23 patients had MCA restenosis （ restenosis group） 1 year after stenting, including 14 cases with 〉50% stenosis and 1 case with MCA occlusion, and 43 patients had no restenosis （non-restenosis group）. The number of endothelial progenitor cells （EPC） was examined by flow cytometry, the adhesion function of EPC was tested by adhesion assay, the migration ability of EPC was tested by Transwell method and serum vascular endothelial growth factor （VEGF） levels were measured by ELISA. The relationship of endothelial repairing function with restenosis was analyzed. Results The MCA stent implantations were successfully performed in all patients. The EPC number （ 33.7 ± 4. 6 vs. 61.6 ± 6.4 ）, adhesion activities （ 26. 1 ± 7.5 vs. 56. 3 ± 9.6 ）, migration activities （ 12. 0 ± 3.9 vs. 21.4 ± 6. 5 ） and serum VEGF level [ （56.7 ±14.6） vs. （89.6 ± 17.32） ng/L] in restenosis group were significantly lower than those in non-restenosis group （t = 18.48, 13.09, 6.34 and 7.73, all P 〈 0. 05）. Conclusion For patients with MCA stenosis after percutaneous stent implantation the increased risk of in-stent restenosis is associated with low level of EPCs and their migration ability, and low serum VEGF level.

关 键 词：大脑中动脉 支架 干细胞 内皮细胞 血管内皮生长因子类 缩窄 病理性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]