动静脉瘘所致的高剪切力减轻支架置入术导致的新生内膜增生  

High wall shear stress caused by arterio-venous fistula reduces neointimal hyperplasia induced by stent implantation

作　　者：刘崇栋 陈锋[1] LIU Chongdong;CHEN Feng(Department of Vascular Surgery,the Second Affiliated Hospital of Nanchang University,Nanchang,Jiangxi 330000,China)

机构地区：[1]南昌大学第二附属医院血管外科,江西省南昌市330000

出　　处：《中国动脉硬化杂志》2021年第2期129-134,共6页Chinese Journal of Arteriosclerosis

基　　金：国家自然科学基金资助项目(81460083、81860094);江西省科技厅自然科学基金资助项目(20142BAB215034、20141BBG70032、20152ACB21026)。

摘　　要：目的研究动静脉瘘(AVF)所致的高剪切力(WSS)对动脉支架植入术后内膜增生(NIH)的影响。方法将36只雄性新西兰大白兔随机分为3组,每组12只。支架组:右颈总动脉(CCA)植入支架;支架+动静脉瘘(AVF)组:右CCA植入支架并行右颈AVF;对照组:未行处理。21天后,取支架段CCA标本用于组织学染色和蛋白质表达分析。结果支架组支架段CCA内WSS维持在基线水平的43.2%~48.9%。支架+AVF组WSS逐渐增加到超过基线水平86%。支架+AVF组NIH较支架组减轻(新生内膜面积:0.19 mm2比0.87 mm2;新生内膜/中膜面积比值:0.18比1.13)。Western blot结果显示,支架+AVF组内皮型一氧化氮合酶(eNOS)水平明显高于支架组,增殖细胞核抗原(PCNA)、血管细胞黏附分子1(VCAM-1)、磷酸化p38丝裂原活化蛋白激酶(p-p38)和磷酸化c-Jun氨基末端激酶(p-JNK)水平明显低于支架组。结论 AVF所致的高WSS减轻了支架植入术后的NIH,其潜在的机制可能与调节eNOS、VCAM-1、p38和JNK的表达和激活有关。Aim To investigate the effect of high wall shear stress(WSS) caused by arterio-venous fistula(AVF) on neointimal hyperplasia(NIH) after stent implantation. Methods 36 male New Zealand white rabbits were randomly divided into three groups with 12 rabbits in each group: stent group: right common carotid artery(CCA) stent implantation;stent+arterio-venous fistula(AVF) group: right CCA stent implantation and right carotid AVF;control group: no treatment. After 21 days, CCA specimen of stent segment was taken for histological staining and protein expression analysis. Results In stent segment CCA, WSS was maintained at 43.2%-48.9% of baseline in stent group, and WSS gradually increased to 86% above baseline level in stent+AVF group. NIH in stent+AVF group was less than that in stent group(neointimal area: 0.19 mm2 vs. 0.87 mm2;neointima-to-media area ratio: 0.18 vs. 1.13). Western blot results showed that the level of endothelial nitric oxide synthase(eNOS) in the stent+AVF group was significantly higher than that in the stent group, while the levels of proliferating cell nuclear antigen(PCNA), vascular cell adhesion molecule-1(VCAM-1), phosphorylated p38 mitogen-activated protein kinase(p-p38) and phosphorylated c-Jun NH2-terminal protein kinase(p-JNK) in the stent+AVF group were significantly lower than those in the stent group. Conclusion High WSS induced by AVF can reduce NIH after stent implantation, and its potential mechanism may be related to the regulation of eNOS, VCAM-1, p38 and JNK expression and activation.

关 键 词：内膜增生 支架 剪切力 动静脉瘘 

分 类 号：R54[医药卫生—心血管疾病] R654.4[医药卫生—内科学]