远程肢体缺血预适应通过上调血管内皮生长因子表达促进急性心肌梗死患者侧支循环形成  

Remote limb ischemic preconditioning promotes coronary collateral circulation in patients with acute myocardial infarction by improving vascular endothelial growth factor expression

作　　者：梁家荣[1] 唐良秋[1] 陈云宪 刘相应 陈宝峰[1] Liang Jiarong;Tang Liangqiu;Chen Yunxian;Liu Xiangying;Chen Baofeng(Department of Cardiovascular,Yue Bei People's Hospital,Shaoguan,512000,China.;不详)

机构地区：[1]粤北人民医院心血管内科,韶关512000

出　　处：《中国循证心血管医学杂志》2023年第2期238-241,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨远程肢体缺血预适应(RLIP)对急性ST段抬高型心肌梗死(STEMI)择期经皮冠状动脉介入治疗(PCI)患者血浆血管内皮生长因子(VEGF)及冠状动脉侧支循环(CCC)的影响。方法选择2019年3月至2020年9月于粤北人民医院就诊因错过再灌注时间窗择期行PCI的STEMI患者90例。随机分为缺血预适应组(n=45,行远程肢体缺血预适应)和对照组(n=45,术前不行远程缺血训练)。所有患者分别于入院时及PCI当日采集静脉血,通过ELISA方法定量血浆VEGF浓度。同时记录及计算两组患者PCI术中侧支循环发生率及级别水平(0~3级)。根据术中侧支循环级别重新分组,以侧支循环2~3级为侧支循环良好组,0~1级为侧支循环不良组,分别检测及统计侧支循环良好组及不良组的VEGF水平,探讨其与冠状动脉(冠脉)侧支循环形成的关系。结果术中发现缺血预适应组侧支循环良好的患者数量远多于对照组(19例vs.7例,P=0.016)。按侧支循环良好与否重新分组,测得两组(侧支循环良好组及侧支循环不良组)入院时VEGF浓度无明显差别[(142.42±22.24)pg/ml vs.(145.37±37.65)pg/ml,P=0.563],而手术当天测得侧支循环良好组血浆VEGF浓度较侧支循环不良组高[(236.26±28.78)pg/ml vs.(154.31±34.96)pg/ml,P=0.002],差异有统计学意义。结论远程肢体缺血预适应可促进STEMI择期PCI患者冠脉侧支循环的形成,其机制可能与远程肢体缺血预适应可上调VEGF表达有关。Objective To investigate the effect of remote limb ischemic preconditioning(RLIP)on plasma vascular endothelial growth factor(VEGF)and coronary collateral circulation(CCC)in patients with elective PCI of acute ST-segment elevation myocardial infarction.Methods The study selected 90 patients(from March 2019 to September 2020 in our hospital)with STEMI undergoing elective PCI.Forty-five patients were randomly selected as the RLIP group and received remote limb ischemia preconditioning.The other 45 cases were selected as the control group without RILP before PCI.Venous blood was collected from all patients on admission and the day of PCI operation.ELISA determined plasma VEGF.The level of CCC(grade 0 to 3)in both groups was recorded(grade 0 to 3)during PCI.We defined the coronary collateral circulation level 2-3 as the group with good collateral circulation and the CCC level 0-1 as the group with poor collateral circulation,the plasma VEGF in both groups was detected and statistically analyzed to explore the relationship between plasma VEGF and the formation of coronary collateral circulation.Results The number of patients with good collateral circulation in the RILP group was significantly higher than that in the control group(19 cases vs.7 cases,P=0.016).There was no significant difference in plasma VEGF between the two groups(good collateral circulation group and poor collateral circulation group)on admission[(142.42±22.24)pg/ml vs.(145.37±37.65)pg/ml,P=0.563].However,on the day of surgery,the plasma VEGF in the group with good collateral circulation was higher than that in the group with poor collateral circulation[(236.26±28.78)pg/ml vs.(154.31±34.96)pg/ml,P=0.002],and the difference was statistically significant.Conclusion Remote limb ischemic preconditioning can promote the formation of coronary collateral circulation in elective PCI patients with acute ST-segment elevation myocardial infarction,and the mechanism may be related to the improvement of VEGF expression.

关 键 词：急性ST段抬高型心肌梗死 远程肢体缺血预适应 冠脉侧支循环 血管内皮生长因子 

分 类 号：R542.22[医药卫生—心血管疾病]