体外心脏震波对冠心病患者外周血内皮祖细胞、血管内皮生长因子和IL-8的影响及疗效评价

发布时间：2018-05-26 15:55

本文选题：体外心脏震波 + 内皮祖细胞　；参考：《医学研究生学报》2017年01期

【摘要】：目的体外心脏震波(CSWT)能够促进缺血心肌血管新生,改善心功能,但其机制尚未明确。文中旨在探讨CSWT对冠心病患者外周血内皮祖细胞(EPCs)、血管内皮生长因子(VEGF)和IL-8的影响及其对缓解患者心绞痛效果的评价。方法回顾性分析昆明医学院第一附属医院心内科2007年9月至2010年12月住院冠心病患者25例,应用震波治疗仪行CSWT,治疗前使用多巴酚丁胺负荷超声心动图和基础及负荷状态下99mTc-甲氧基异丁基异腈(99mTc-MIBI)心肌灌注显像识别并定位缺血/存活心肌。以3个月为1个震波治疗周期,共行9次CSWT治疗。所有患者均在治疗前后采集外周血单个核细胞培养成EPCs,观察其形态和数量。使用激光共聚焦显微镜鉴定EPCs;流式细胞术直接检测外周血EPCs数量;ELISA法检测治疗前后外周血细胞因子VEGF、IL-8的表达水平。另外,在治疗前后行6 min步行距离、NYHA心功能分级、CCS心绞痛分级、SAQ评分、硝酸甘油用量临床指标评估;测量左室舒张末内径(LVDD)和左室射血分数(LVEF);采用静息及负荷状态下收缩期峰值应变率(PSSR)和心肌灌注显像(MPI)评价局部心肌收缩功能和血流灌注。结果 CSWT治疗后,体外培养的EPCs数量(34.52±6.58)和细胞集落形成数(12.44±2.66)分别较治疗前(19.56±4.28、5.04±1.90)明显增多(P0.001)。流式细胞仪检测外周血循环中EPCs数量较治疗前亦明显增多[(904.73±94.77)/m L vs(815.68±101.08)/m L,P0.05]。治疗后外周血细胞因子VEGF[(155.29±23.6)pg/m L]、IL-8[(149.37±46.51)pg/m L]均较治疗前(122.26±18.85、21.86±5.96)pg/m L明显增加(P0.01)。与治疗前相比,治疗后患者6 min步行距离、NYHA心功能分级、CCS心绞痛分级、SAQ评分、硝酸甘油用量均得到明显改善(P0.01),LVDD和LVEF差异无统计学意义(P0.05)。治疗后MPI在静息(2.16±0.16)和负荷(1.40±0.16)状态下分别较治疗前(1.04±0.19、0.80±0.16)明显增加(P0.01)。PSSR基础状态下治疗前后差异无统计学意义(P0.05),负荷状态下明显增强[(2.02±1.00)vs(1.35±0.66),P0.01]。结论 CSWT能够提高冠心病患者外周血VEGF、IL-8的表达,促进EPCs的功能,在缓解患者心绞痛症状、改善心功能、提高运动耐量等方面可起到重要作用。
[Abstract]:Objective CSWTs can promote angiogenesis and improve cardiac function in ischemic myocardium, but the mechanism is not clear. The purpose of this study was to investigate the effects of CSWT on endothelial progenitor cell (EPC), vascular endothelial growth factor (VEGF) and IL-8 in peripheral blood of patients with coronary heart disease (CHD), and to evaluate the effect of IL-8 on relieving angina pectoris in patients with coronary heart disease (CHD). Methods from September 2007 to December 2010, 25 patients with coronary heart disease in Department of Cardiology, the first affiliated Hospital of Kunming Medical College, were retrospectively analyzed. Before treatment, dobutamine stress echocardiography and 99mTc- methoxy isobutyl isonitrile 99mTc-MIBI myocardial perfusion imaging were used to identify and locate the ischemic / viable myocardium. A shock wave treatment cycle of 3 months was used for 9 times of CSWT therapy. Peripheral blood mononuclear cells (PBMC) were collected and cultured into EPCs before and after treatment. EPCs were identified by laser confocal microscopy and the expression of VEGF IL-8 was detected by flow cytometry and Elisa. In addition, 6 min walking distance and cardiac function grade, CCS angina pectoris grade and SAQ score, nitroglycerin dosage were evaluated before and after treatment. Left ventricular end-diastolic diameter (LVDDD) and left ventricular ejection fraction (LVEFV) were measured. Systolic peak strain rate (PSSRR) and myocardial perfusion imaging (MPI) were used to evaluate regional myocardial systolic function and perfusion. Results after treatment with CSWT, the number of EPCs cultured in vitro was 34.52 卤6.58) and the number of colony formation was 12.44 卤2.66), which was significantly higher than that before treatment (19.56 卤4.285.04 卤1.90). The number of EPCs in peripheral blood circulation was also significantly increased by flow cytometry [904.73 卤94.77 min / mL vs(815.68 卤101.08 渭 m / mL P 0.05]. The peripheral blood cytokine VEGF [155.29 卤23.6)pg/m L] IL-8 [149.37 卤46.51)pg/m L] was significantly higher than that before treatment (122.26 卤18.85 卤21.86 卤5.96)pg/m L). Compared with before and after treatment, there was no significant difference in 6 min walking distance and cardiac function grade (CCS) and angina pectoris score (SAQ) and nitroglycerin dosage (P 0.01) and LVEF (P 0.05). After treatment, MPI was significantly increased at rest (2.16 卤0.16) and load (1.40 卤0.16) than that before treatment (1.04 卤0.19 卤0.80 卤0.16), respectively. There was no significant difference between before and after treatment in the basic state of P0.01U. PSSR, but significantly increased under load [2.02 卤1.00)vs(1.35 卤0.666 P0.01]. Conclusion CSWT can increase the expression of VEGF IL-8 in peripheral blood of patients with coronary heart disease, promote the function of EPCs, and play an important role in alleviating the symptoms of angina pectoris, improving cardiac function and improving exercise tolerance.
【作者单位】：昆明医科大学第一附属医院心内科;
【基金】：国家自然科学基金(81260027) 云南省科技计划项目-省应用基础研究(昆医联合专项)(2014FZ023)
【分类号】：R541.4

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