冠状动脉内膜剥脱斑块脂质分析及影响术后再狭窄机制初探  

Lipid analysis of coronary atherosclerotic plaques and the mechanism of restenosis after coronary endarterectomy

作　　者：汪川[1] 张帆[1] 李平[1] 岳新伟 于薇[3] 罗程[4] Wang Chuan;Zhang Fan;Li Ping;Yue Xinwei;Yu Wei;Luo Cheng(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;School of Information and Communication Engineering,Beijing Information Science and Technology University,Beijing 100101,China;Department of Radiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Cardiothoracic Surgery,the First Affiliated Hospital of Guangxi Medical University,Nanning 530000,China)

机构地区：[1]首都医科大学附属北京安贞医院心外科,100029 [2]北京信息科技大学信息与通信工程学院,100101 [3]首都医科大学附属北京安贞医院影像科,100029 [4]广西医科大学第一附属医院心胸外科,南宁530000

出　　处：《中华胸心血管外科杂志》2022年第1期44-48,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(81870339)。

摘　　要：目的分析冠状动脉内膜剥脱斑块的脂质成分,并探讨其影响内膜剥脱术(coronary endarterectomy,CE)中、长期疗效的机制。方法自2018年1月至2019年12月,选取北京安贞医院冠状动脉外科术前合并高脂血症病史的弥漫性冠状动脉病变(diffuse coronary artery disease,DCAD)患者共50例,拟行冠状动脉旁路移植联合前降支内膜剥脱(CE)术,术前签署知情同意书后术中取冠状动脉内膜剥脱及血浆样本,并经术后复查核磁共振冠状动脉斑块显像(atherosclerosis T1-weighted characterization,CATCH)检查并联合功率域非正交多址接入(power domain non-orthogonal multiple access,NOMA)集成框架技术分析中远期冠状动脉再狭窄率后作为高风险组(>25%,研究组)及匹配低风险组(对照组),两组进行脂质学及分子生物学分析检测斑块标本组织及细胞色素P4503A4酶(CYP3A4)含量。结果两组各入选8例患者,研究组患者冠状动脉内膜剥脱斑块脂质学分析后发现4α-羟基胆固醇(4α-hydroxycholesterol,4α-OHC)含量较对照组明显增高(0.050μmol/g对0.016μmol/g,P<0.05);同时研究组术后12个月复查冠状动脉T1加权特征核磁显像结果显示对照组通畅率优于研究组[冠状动脉管腔狭窄率(9.0±1.9)%对(22.3±2.3)%,P<0.05]。CYP3A4含量对比:研究组血浆CYP3A4含量均高于对照组[即刻(0.88±0.05)ng/ml对(0.45±0.03)ng/ml,术后12个月(2.08±0.40)ng/ml对(1.58±0.16)ng/ml,P<0.05]。结论高表达4α-OHC可能加速CE术后动脉粥样硬化(atherosclerosis,AS)造成CE术后中远期再狭窄;同时证实4α-OHC是CYP3A4的生物活性标志物,为进一步阐明CE术后AS进展机制奠定了一定的前期基础。Objective To analyze the lipid composition of coronary atherosclerotic plaques and explore the mechanism of its influence on the medium and long-term efficacy of coronary endarterectomy(CE).Methods From January 2018 to December 2019,a total of 50 patients with diffuse coronary artery disease(DCAD)and hyperlipidemia in Beijing Anzhen Hospital were enrolled to undergo coronary artery bypass grafting combined with anterior descending CE.After the informed consent was signed before the operation,the coronary endarterectomy plaque tissue and blood plasma samples were taken during the operation.Patients were further examined by coronary atherosclerosis T1-weighted characterization(CATCH)and power domain non-orthogonal multiple access(NOMA)postoperatively to analyze middle and long-term coronary restenosis risks.They were divided into high-risk group(restenosis rate>25%,study group)and matched low-risk group(control group).Lipid and molecular biological analysis were performed in the two groups to detect the tissue and cytochrome P4503A4 enzyme(CYP3A4)content of plaque samples.Results 8 patients were enrolled in each group.The lipid analysis showed that and tissue samples from patients in the study group had a significantly higher level of 4α-Hydroxycholesterol(4α-OHC)as compared to the control group(0.050μmol/g vs.0.016μmol/g,P<0.05).Further,12 months after the operation,CATCH results showed that the patency rate of the control group was better than that of the study group[coronary artery stenosis rate(9.01±1.9)%vs.(22.31±2.3)%,P<0.05].Comparison of CYP3A4 content showed that:the CYP3A4 in blood plasma for the study group was higher than that in the control group[immediate(0.88±0.05)ng/ml vs.(0.45±0.03)ng/ml and(2.08±0.40)ng/ml vs.(1.58±0.16)ng/ml,P<0.05].Conclusion High expression of 4α-OHC may accelerate atherosclerosis(AS)after CE and cause restenosis in the middle and long term;It was also confirmed that 4α-OHC is a biomarker of CYP3A4,which suggests for further investigation of the mechanism of progres

关 键 词：4α-羟基胆固醇 细胞色素P4503A4酶 冠状动脉粥样硬化 核磁共振冠状动脉斑块显像 功率域非正交多址接入 

分 类 号：R654.2[医药卫生—外科学]