放疗抑制重建术后人工血管新生内膜的实验研究  

Radiation suppresses neointimal hyperplasia after revascularization

作　　者：袁丽琴[1] 舒畅[2] 周晓[3] 张文波[2] 方坤[2] 李鑫[2] 李全明[2] 

机构地区：[1]中南大学湘雅二医院普通外科,长沙410011 [2]中南大学湘雅二医院血管外科,长沙410011 [3]中南大学湘雅医学院附属肿瘤医院头颈外科,长沙410013

出　　处：《首都医科大学学报》2015年第1期34-39,共6页Journal of Capital Medical University

基　　金：国家自然科学基金(81370430)~~

摘　　要：目的构建膨体聚四氟乙烯(expanded polytetrafluoroethylene,e PTFE)人工血管置换杂种犬肾动脉平面下腹主动脉的血管重建手术模型。探讨总剂量28Gy的体外分割放射治疗影响重建术后人工血管内膜增生的机制。方法健康杂种犬12只,采用数字表法随机均分成放疗组和对照组。均先行肾下腹主动脉段的人工血管置换重建术。放疗组于术后2周后对标记区血管行总剂量28Gy的体外放疗。对照组则不放疗。重建术后5周观察比较两组移植术后的人工血管新生内膜的增生情况,Skp2、p27kip1和增生细胞核抗原(proliferating cell nuclear antigen,PCNA)的蛋白和mRNA的表达情况。结果放疗组的人工血管吻合口内膜增生程度明显比对照组降低(P<0.01)。放疗组的Skp2、PCNA的蛋白表达及mRNA表达较对照组明显减低,而p27kip1的mRNA表达较对照组明显增加(P<0.01)。结论术后体外分割放疗(28Gy)在短期内可以通过抑制血管平滑肌细胞(vascular smooth muscle cell,VSMC)的增生,从而抑制重建术后的人工血管的内膜增生。Objective To study the effect of postoperative fractionated X-ray radiotherapy,at a total dose of 28 Gy,on neointimal formation and strive to further elucidate the mechanisms of neointimal hyperplasia in the abdominal expanded polytetrafluoroethylene（ e PTFE） prosthetic vascular graft. Methods The subrenal abdominal aortas of 12 mongrel dogs were replaced with an e PTFE graft. The dogs were randomly divided into either a radiotherapy group or a non-radiotherapy control group. Grafts were harvested at five weeks after surgery for comparing the thickness of neointimal formation and the expression of PCNA,S phase kinase associated protein 2（ Skp2） and p27kip1 in the two groups. Results We observed that the graft neointimal and anastomotic vessel wall of the radiotherapy group were significantly thinner than those of the control group（ P〈0. 01）. The mRNA and the protein expression of p27kip1 was elevated in the neointimal area after irradiation（ P〈0. 01）. The mRNA and the protein expression of PCNA and Skp2 were significantly down-regulated in the radiotherapy group（ P〈0. 01）. Conclusion Postoperative fractionated radiotherapy（ 28 Gy） after an e PTFE graft replacement of the abdominal aorta suppressed the development of neointimal hyperplasia and the proliferation of vascular smooth muscle cell（ VSMC） in the graft in the short term.

关 键 词：人工血管 放疗 内膜增生 SKP2 增生细胞核抗原 P27KIP1 

分 类 号：R622[医药卫生—整形外科]