梗死心肌侧枝血管形成与缺氧诱导因子-1α及血管内皮生长因子A表达水平的关系及临床意义  

Relationship between Myocardial Collateral Vessel Formation and the Levels of Hypoxia-Inducible Factor 1-alpha and Vascular Endothelial Growth Factor A and Its Clinical Significance

作　　者：戴宇翔[1] 王审 李晨光[1] 黄浙勇[1] 陆浩[1] 常书福[1] 钱菊英[1] 葛雷[1] 王齐兵[1] 颜彦[1] 樊冰[1] 张峰[1] 姚康[1] 马剑英[1] 黄东[1] 葛均波[1] 

机构地区：[1]复旦大学附属中山医院心内科,上海200032 [2]浙江省温岭市第一人民医院心内科,浙江温岭317500

出　　处：《中国临床医学》2015年第3期305-309,共5页Chinese Journal of Clinical Medicine

摘　　要：目的：探讨冠状动脉慢性完全闭塞（chronic total occlusion,CTO）后梗死心肌中侧枝血管形成与缺氧诱导因子-1α（hypoxia-inducible factor 1-alpha,HIF-1α）及血管内皮生长因子A（vascular endothelial growth factor A,VEGF-A）表达水平的关系及其临床意义。方法：连续收集经冠状动脉造影明确为完全闭塞病变者214例,结合患者的临床表现及（或）影像学资料,确诊为CTO者89例。采用ELISA法检测HIF-1α和VEGF-A的蛋白水平;提取外周血单个核细胞（peripheral blood mononuclear cell,PBMC）,用定量PCR法测定PBMC中VEGF-A的mRNA水平。采用JMP9.0和SPSS18.0统计软件进行统计学处理。结果：比较各组糖尿病患者比例,Rentrop 2级组（11/31,35.5%）和3级组（3/20,15.0%）显著低于0-1级组（18/38,47.4%）,P〈0.05;比较各组的空腹血糖水平,Rentrop 2级组（6.67±1.41）mmol/L）和3级组（5.48±1.26）mmol/L）显著低于0-1级组（7.24±1.39）mmol/L）,P〈0.05;比较各组患者中临床心衰（NYHAⅡ-Ⅳ级）的比例,Rentrop 2级组（12/31,38.7%）和3级组（3/20,15.0%）显著低于0-1级组（20/38,52.6%）,P〈0.05;比较各组HIF-1α和VEGF-A的蛋白水平,Rentrop 2级组[（85.5±27.7）pg/mL,（139.5±42.1）pg/mL]和3级组[（103.3±30.2）pg/mL,（162.6±43.3）pg/mL]显著高于0-1级组[（42.0±16.1）pg/mL,（76.5±32.2）pg/mL],P均〈0.01;比较各组HIF-1α和VEGF-A的mRNA水平,Rentrop 2级组（1.31±0.46）和3级组（1.38±0.44）VEGF-A的mRNA相对表达水平显著高于0-1级组（1.00±0.28）,P〈0.01。结论：慢性持续缺血、缺氧所导致的HIF-1α和VEGF表达增加在促进冠状动脉侧枝循环的建立、增加心肌血供、改善预后、减少临床心功能不全的发生率方面具有重要意义。Objective：The goal of this study was to analyze the clinical significance of relationship between myocardial collateral and the levels of hypoxia-inducible factor 1-alpha（HIF-1α）and vascular endothelial growth factor A（VEGF-A）in patients with coronary chronic total occlusion lesion.Methods：89 patients with coronary chronic total occlusion lesion confirmed by clinical data and coronary angiography were identified.The levels of HIF-1αand VEGF-A were measured by ELISA,and the relative expression of VEGF-A of peripheral blood mononuclear cell（PBMC）were measured by real-time PCR.The results were statistically analyzed by the statistical programme for social sciences（SPSS version18.0）and software SAS JMP9.0.Results：Compared to Rentrop0-1 grade group（18/38,47.4%）,Rentrop2（11/31,35.5%）and Rentrop3（3/20,15.0%）grade group had fewer diabetes mellitus.Rentrop2[（6.67±1.41）mmol/L]and Rentrop3[（5.48±1.26）mmol/L]grade group had lower fasting blood glucose than Rentrop0-1 grade group[（7.24±1.39）mmol/L].Rentrop2（12/31,38.7%）and Rentrop3（3/20,15.0%）grade group had fewer clinical heart failure（NYHA Ⅱ -Ⅳ grade）than Rentrop 0-1 grade group（20/38,52.6%）.Rentrop 2 [（85.5±27.7）pg/mL,（139.5±42.1）pg/mL]and Rentrop 3 [（103.3±30.2）pg/mL,（162.6±43.3）pg/mL]grade group had higher levels of HIF-1αand VEGF-A than Rentrop 0-1 grade group[（42.0±16.1）pg/mL,（76.5±32.2）pg/mL].Rentrop 2（1.31±0.46）and Rentrop 3（1.38±0.44）grade group had higher level of relative expression of VEGF-A in PBMC than Rentrop 0-1 grade group（1.00±0.28）.Conclusions：Chronic and consistent ischemia and hypoxia induced the increase of expression of HIF-1αand VEGF-A is important for establishment of coronary collateral,increasing blood supply and improving the heart function and prognosis.

关 键 词：冠状动脉慢性完全闭塞 冠状动脉侧枝循环 缺氧诱导因子-1Α 血管内皮生长因子A 

分 类 号：R542.2[医药卫生—心血管疾病]