体外循环辅助行冠状动脉旁路移植术对Klotho-FGF23轴的影响及血管生长因子的表达变化  

Impact of cardiopulmonary bypass coronary artery bypass grafting on the expression of Klotho-FGF23 axis and angiogenic factor status

作　　者：贾政 李亚雄[1] 邹弘麟[1] 刘茜[1] 李华[1] 王洪涛[1] 陈志鹏[1] 孟凡棣 邢正江[1] JIA Zheng;LI Ya-xiong;ZOU Hong-lin;LIU Qian;LI Hua;WANG Hong-tao;CHEN Zhi-peng;MENG Fan-di;XING Zheng-jiang(Cardiovascular Surgery,Kunming Medical University Affiliated Yan'an Hospital,Kunming 650051,China)

机构地区：[1]昆明医科大学附属延安医院心脏大血管外科,云南省昆明市650051

出　　处：《中国心血管病研究》2021年第12期1108-1114,共7页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金(82060093);云南省基础研究计划-昆医联合专项(2018FE001-276);云南省高层次卫生健康技术人才培养计划(H-2018028);昆明市卫生科技人才培养计划(2018SW-后备-06)。

摘　　要：目的探讨体外循环辅助行冠状动脉旁路移植术(CABG)对Klotho-FGF23轴的影响,以及对血管生长因子的表达变化产生的意义。方法选取2018年8月至2020年6月在我院心脏大血管外科接受CABG患者67例作为研究组,分别于术前、术后12h、术后48h测定抗衰老相关基因(Klotho)、成纤维细胞生长因子23(FGF23)、核转录因子-κB(NF-κB)、血管生成素-2(Ang-2)、内皮素-1(ET-1)、弹性蛋白微原纤维界面因子-1(EMILIN-1)、纤维粘连蛋白(FN)、血管内皮细胞生长因子(VEGF)的表达水平,随后将KlothoFGF23轴分别在术前、术后12 h及术后48 h与上述各因子进行相关性分析。结果本研究共纳入67例接受CABG患者,接受单纯CABG患者46例(68.66%),同时接受单机械瓣置换者13例(19.40%),双机械瓣置换者6例(8.95%),改良Cabrol术者2例(2.99%)。与CABG术前相比,Klotho、NF-κB、Ang-2、EMILIN-1、FN的表达升高(P值分别为0.002、0.048、0.025、0.032、0.031),FGF23表达降低(P=0.034)。随时间延长,在术后48 h,Klotho、ET-1、EMILIN-1、VEGF水平仍表达升高(P值分别为0.048、0.029、0.006、0.004);FGF23仍表达降低(P=0.042)。在CABG术前,Klotho及FGF23均与Ang-2、EMILIN-1、ET-1、NF-κB、FN呈显著正相关(r值分别为0.731、0.484;0.718、0.422;0.765、0.245;0.857、0.260;0.757、0.397;P值均<0.05),FGF23还与VEGF呈显著正相关(r=0.549;P<0.05);在CABG术后12 h,Klotho及FGF23均与Ang-2、EMILIN-1、NF-κB呈显著正相关(r值分别为0.798、0.314;0.842、0.258;0.943、0.276;P值均<0.05),Klotho还与ET-1、FN呈显著正相关(r值分别为0.861、0.886;P值均<0.05);在CABG术后48 h,Klotho与Ang-2、EMILIN-1、ET-1、NF-κB、FN、VEGF呈显著正相关(r值分别为0.721、0.748、0.723、0.819、0.771、0.431;P值均<0.05)。结论体外循环CABG后Klotho表达上调、FGF23表达下调,符合Klotho-FGF23轴调控特征;Klotho-FGF23轴能够调控促血管生长因子及促血管纤维化因子的表达。Objective To explore the effect of cardiopulmonary bypass assisted coronary artery bypass grafting(CABG) on the Klotho-FGF23 axis and the significance of changes in the expression of angiogenic factors. Methods 67 patients who underwent coronary artery bypass grafting at our unit from August 2018 to June 2020 were selected as the research group. Anti-aging related gene(Klotho), Fibroblast growth factor 23(FGF23), nuclear transcription factor κB(NF-κB), angiopoietin-2(Ang-2), endothelin-1(ET-1), elastin microfibril interface factor-1(EMILIN-1), firbronectin(FN), and vascular endothelial cell growth factor(VEGF) were test at pre-operation, post-operation 12 h, and post-operation 48 h. Then, Klotho-FGF23 axis was analyzed for the correlation with the above factors at the three time points. Results The study included 67 cases receiving CABG,46 cases(68.66%) received CABG alone, 13 cases(19.40%) receiving single mechanical valve replacement and 6 cases(8.95%) receiving dual mechanical valve replacement at the same time. 2 cases(2.99%) underwent modified Cabrol surgery. Compared with pre-CABG, the expression of Klotho, NF-κB, Ang-2, EMILIN-1 and FN increased(P values=0.002, 0.048, 0.025, 0.032, 0.031), and the expression of FGF23 decreased(P=0.034). As time passed, the expression of Klotho, ET-1, EMILIN-1, and VEGF still increased at post-operation 48 h(P values=0.048, 0.029, 0.006, 0.004) but FGF23 expression still decreased(P=0.042). Before CABG surgery, both Klotho and FGF23 were significantly positively correlated with Ang-2, EMILIN-1, ET-1, NF-κB, and FN(r values=0.731,0.484;0.718, 0.422;0.765, 0.245;0.857, 0.260;0.757, 0.397;all P values<0.05). FGF23 was also significantly positively correlated with VEGF(r=0.549;P<0.05). At post-operation 12 h, both Klotho and FGF23 were significantly positively correlated with Ang-2, EMILIN-1, and NF-κB(r values=0.798, 0.314;0.842, 0.258;0.943,0.276;all P values<0.05);Klotho was also significantly positively correlated with ET-1 and FN(r values=0.861 and 0.886;all P values<

关 键 词：KLOTHO FGF23 调节轴 冠状动脉旁路移植术 桥血管融合 

分 类 号：R654.2[医药卫生—外科学]