呼吸暂停综合征对支架术后内膜增殖的影响  

Influence of obstructive sleep apnea syndrome on neointimal proliferation after stent implantation

作　　者：郑华峰[1] 

机构地区：[1]北京大学深圳医院心内科,广东深圳528000

出　　处：《岭南心血管病杂志》2015年第4期478-481,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨支架术后内膜增殖与阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)的关系及其机制。方法将入选的60例植入Xience V(Abbott Vascular)支架的患者分为两组:OSAS组30例(应用多导睡眠监测确诊);非OSAS组30例。分别于术前和术后即刻应用血管内超声(intravascular ultrasound,IVUS)检测并记录患者冠状动脉特征,于术后6个月应用IVUS观察和分析内膜增殖情况。分别于支架术前及术后6个月采集患者静脉血检测干扰素γ(interleukin-γ,INF-γ),白细胞介素(interleukin,IL)-2(Th1型炎症介质)和IL-10(Th2型炎症介质)的浓度。结果 IVUS结果显示,支架术后6个月时,支架覆盖和内膜愈合良好。新生内膜面积OASA组为(1.44±0.89)mm2,非OASA组为(1.11±0.89)mm2,两组比较差异有统计学意义(P<0.05)。术后即刻血浆中炎症介质INF-γ及IL-2浓度在OASA组要高于非OASA组,差异有统计学意义(P<0.05);而IL-10浓度则相反,在OASA组略低于非OASA组,差异有统计学意义(P<0.05)。术后6个月时,炎症介质的变化趋势为Th1型炎症介质INF-γ及IL-2浓度上调,而Th2型炎症因子IL-10浓度下调。术后即刻,Th1型炎症介质INF-γ,IL-2浓度在OSAS组要高于非OSAS组,差异有统计学意义(P<0.05);在术后6个月时,INF-γ,IL-2浓度在非OSAS组与其术后即刻时相比存在差异,但差异并无统计学意义(P>0.05)。IL-10浓度在术后6个月时明显升高,与其术后即刻时浓度相比,差异有统计学意义(P<0.05)。结论 OSAS患者支架植入前后炎症紊乱以及术后内膜增殖更加明显。TH1/Th2炎性介质的紊乱或许是导致术后内膜增殖显著发生的原因。Objectives To explore the relationship and mechanism of neointimal proliferation and obstructive sleep apnea syndrome（OSAS） after stent implantation. Methods The 60 chosen patients with Xience V（Abbott Vascular）stent implanted were divided into two groups ： OSAS group with 30 patients（applying polysomnography for diagnosis）and non-OSAS group with the other 30 patients. Intravascular ultrasound（IVUS） was used before and immediately after implantation in monitoring and recording the coronary characteristics. Six months after implantation, IVUS was used for observing and analyzing the neointimal condition. Concentrations of interleukin- γ（INF-γ）, interleukin（IL）-2（Th1inflammatory mediators） and IL-10（Th2 inflammatory mediator） were detected respectively before and 6 months after implantation. Results IVUS results showed a good stent coverage and a healing condition 6 months after implantation.Newly-formed intimal areas of OSAS group were（1.44 ±0.89） mm2 with non-OSAS group of（1.11 ±0.89） mm2. The difference between the two groups was of statistical significance（P〈0.05）. Immediately after stent implantation, plasma concentrations of inflammatory mediators INF- γ and IL-2 in OASA group were significantly higher than those in nonOSAS group（P〈0.05）. On the contrary, plasma concentration of IL-10 was higher in non-OSAS group（P〈0.05）. At 6months after stent implantation, the trend of the inflammatory mediators was that concentrations of Th1 inflammatory mediators INF-γ and IL-2 increased with a decrease in concentration of Th2 inflammatory mediator IL-10. Immediately after stent implantation, concentrations of Th1 inflammatory mediators INF- γ and IL-2 in OSAS group were higher than those in non-OSAS group（P〈0.05）. Concentrations of INF-γ and IL-2 in non-OSAS group at 6 months after stentimplantation were different from those immediately after stent implantation. However, the difference was of no statistical significance（P〈0.05）. IL-10 has a s

关 键 词：呼吸暂停综合征 细胞因子 内膜增殖 介入治疗 

分 类 号：R825.6[医药卫生—临床医学]