冠状动脉搭桥术后静脉桥狭窄和新生易损斑块形成机制的研究进展
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摘要
冠状动脉搭桥术术后发生桥血管病变是一种常见的现象,血栓形成、内皮功能障碍、血管痉挛和氧化应激是导致病变的重要机制。相比于动脉桥,静脉桥更易于发生病变,这与静脉本身的解剖形态和功能特征有着很大的关系。急性血栓形成、血管内膜增生和易损斑块形成是静脉桥不同时期发生病变的重要机制。使用抗血小板和调脂药物等冠心病二级预防药物有助于提高桥血管的开通率。寻找桥血管病变的预测因子及相关基因通路有望从细胞及分子学水平为静脉桥疾病提供新的研究方向。本文拟对冠状动脉搭桥术后发生静脉桥狭窄和新生易损斑块病变形成机制的研究进展作一综述。
Graft lesions after coronary artery bypass graft are the common phenomenon. Thrombosis, endothelial dysfunction, vasospasm, and oxidative stress are important mechanisms leading to the lesions. Compared with arterial bypass graft, venous bypass graft is more susceptible to lesions, which is closely related to the anatomical morphology and functional characteristics of veins themselves. Acute thrombosis, intimal hyperplasia and vulnerable plaque formation are important mechanisms of vein graft lesions during different stages. Secondary prevention drugs such as antiplatelet and lipid-lowering drugs can improve the patency rate of bypass grafts. The search for predictors and related gene pathways of vein graft disease is expected to provide new research directions for vein graft disease at cellular and molecular levels. The review summarizes the research progress on pathogenesis of vein bypass graft stenosis and new vulnerable plaque lesions after coronary artery bypass graft.
Graft lesions after coronary artery bypass graft are the common phenomenon. Thrombosis, endothelial dysfunction, vasospasm, and oxidative stress are important mechanisms leading to the lesions. Compared with arterial bypass graft, venous bypass graft is more susceptible to lesions, which is closely related to the anatomical morphology and functional characteristics of veins themselves. Acute thrombosis, intimal hyperplasia and vulnerable plaque formation are important mechanisms of vein graft lesions during different stages. Secondary prevention drugs such as antiplatelet and lipid-lowering drugs can improve the patency rate of bypass grafts. The search for predictors and related gene pathways of vein graft disease is expected to provide new research directions for vein graft disease at cellular and molecular levels. The review summarizes the research progress on pathogenesis of vein bypass graft stenosis and new vulnerable plaque lesions after coronary artery bypass graft.
引文
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[2] Baikoussis NG,Papakonstantinou NA,Apostolakis E.Radial artery as graft for coronary artery bypass surgery:advantages and disadvantages for its usage focused on structural and biological characteristics[J].J Cardiol,2014,63(5):321-328.
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[10] Benjamin K,Anthony D,Leanne D,et al.Hemodynamic influence on smooth muscle cell kinetics and phenotype during early vein graft adaptation[J].Ann Biomed Eng,2017,45(3):644-655.
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[13] Nocerino AG,Achenbach S,Taylor AJ.Meta-analysis of effect of single versus dual antiplatelet therapy on early patency of bypass conduits after coronary artery bypass grafting[J].Am J Cardiol,2013,112(10):1576-1579.
[14] 张楠,刘寅.冠状动脉旁路移植术后桥血管病变的危险因素及防治策略[J].临床荟萃,2016,31(11):1262-1267.
[15] Valgimigli M,Bueno H,Byrne RA,et al.2017 ESC focused update on dual antiplatelet therapy in coronaryartery disease developed in collaboration with EACTS:the task force for dual antiplatelet therapy in coronary artery disease of the European society of cardiology (ESC) and of the European association for cardio-thoracic surgery (EACTS)[J].Eur Heart J,2018,39(3):213-254.
[16] 戴龙圣,顾承雄,于洋.冠状动脉旁路移植术后静脉桥血管通畅率的研究进展[J].心肺血管病杂志,2014,33(3):453-455.
[17] Kulik A,Ruel M,Jneid H,et al.Secondary prevention after coronary artery bypass graft surgery:a scientific statement from the American heart association[J].Circulation,2015,131(10):927-964.
[18] Helgadottir A,Thorleifsson G,Manolescu A,et al.A common variant on chromosome 9p21 affects the risk of myocardial infarction[J].Science,2007,316(5830):1491-1493.
[19] Shah AA,Haynes C,Craig DM,et al.Genetic variants associated with vein graft stenosis after coronary artery bypass grafting[J].Heart Surg Forum,2015,18(1):E1-E5.
[20] Yang Y,Trent MB,He N,et al.Glutathione-S-transferase A4-4 modulates oxidative stress in endothelium:possible role in human atherosclerosis[J].Atherosclerosis,2004,173(2):211-221.
[21] Yang Y,Yang Y,Xu Y,et al.Endothelial glutathione-S-transferase A4-4 protects against oxidative stress and modulates iNOS expression through NF-kappa B translocation[J].Toxicol Appl Pharmacol,2008,230(2):187-196.
[22] Liu Q,Yin X,Li M,et al.Identification of potential crucial genes and pathways associated with vein graft restenosis based on gene expression analysis in experimental rabbits[J].Peer J,2018,16(6):e4704.
[2] Baikoussis NG,Papakonstantinou NA,Apostolakis E.Radial artery as graft for coronary artery bypass surgery:advantages and disadvantages for its usage focused on structural and biological characteristics[J].J Cardiol,2014,63(5):321-328.
[3] Joshi FR,Biasco L,Pedersen F,et al.Invasive angiography and revascularization in patients with stable angina following prior coronary artery bypass grafting:results from the east denmark heart registry[J].Catheter Cardiovasc Interv,2017,89(3):341-349.
[4] Eyüboglu M,Koyuncu I.Duration after coronary artery bypass graft surgery and saphenous vein graft disease[J].Anatol J Cardiol,2015,15(12):1034-1037.
[5] 李丽,赵强,盖鲁粤,等.冠状动脉旁路移植术后移植血管的转归及影响因素分析[J].中国循环杂志,2017,32(2):128-131.
[6] 李海明,顾承雄.静脉桥血管内膜增生机制的研究进展[J].心肺血管病杂志,2017,36(3):237-239.
[7] Harskamp RE,Lopes RD,Baisden CE,et al.Saphenous vein graft failure after coronary artery bypass surgery:pathophysiology,management,and future directions[J].Ann Surg,2013,257(5):824-833.
[8] Yahagi K,Kolodgie FD,Otsuka F,et al.Pathophysiology of native coronary,vein graft,and in-stent atherosclerosis[J].Nat Rev Cardiol,2016,13(2):79-98.
[9] Storey RF.Exploring mechanisms of graft occlusion toward improved outcomes in coronary artery bypass graft surgery[J].J Am Coll Cardiol,2011,57(9):1078-1080.
[10] Benjamin K,Anthony D,Leanne D,et al.Hemodynamic influence on smooth muscle cell kinetics and phenotype during early vein graft adaptation[J].Ann Biomed Eng,2017,45(3):644-655.
[11] Yazdani SK,Farb A,Nakano M,et al.Pathology of drug-eluting versus bare-metal stents insaphenous vein bypass graft lesions[J].JACC Cardiovasc Interv,2012,5(6):666-674.
[12] Yanagawa B,Algarni KD,Singh SK,et al.Clinical,biochemical,and genetic predictors of coronary artery bypass graft failure[J].J Thorac Cardiovasc Surg,2014,148(2):515-520.
[13] Nocerino AG,Achenbach S,Taylor AJ.Meta-analysis of effect of single versus dual antiplatelet therapy on early patency of bypass conduits after coronary artery bypass grafting[J].Am J Cardiol,2013,112(10):1576-1579.
[14] 张楠,刘寅.冠状动脉旁路移植术后桥血管病变的危险因素及防治策略[J].临床荟萃,2016,31(11):1262-1267.
[15] Valgimigli M,Bueno H,Byrne RA,et al.2017 ESC focused update on dual antiplatelet therapy in coronaryartery disease developed in collaboration with EACTS:the task force for dual antiplatelet therapy in coronary artery disease of the European society of cardiology (ESC) and of the European association for cardio-thoracic surgery (EACTS)[J].Eur Heart J,2018,39(3):213-254.
[16] 戴龙圣,顾承雄,于洋.冠状动脉旁路移植术后静脉桥血管通畅率的研究进展[J].心肺血管病杂志,2014,33(3):453-455.
[17] Kulik A,Ruel M,Jneid H,et al.Secondary prevention after coronary artery bypass graft surgery:a scientific statement from the American heart association[J].Circulation,2015,131(10):927-964.
[18] Helgadottir A,Thorleifsson G,Manolescu A,et al.A common variant on chromosome 9p21 affects the risk of myocardial infarction[J].Science,2007,316(5830):1491-1493.
[19] Shah AA,Haynes C,Craig DM,et al.Genetic variants associated with vein graft stenosis after coronary artery bypass grafting[J].Heart Surg Forum,2015,18(1):E1-E5.
[20] Yang Y,Trent MB,He N,et al.Glutathione-S-transferase A4-4 modulates oxidative stress in endothelium:possible role in human atherosclerosis[J].Atherosclerosis,2004,173(2):211-221.
[21] Yang Y,Yang Y,Xu Y,et al.Endothelial glutathione-S-transferase A4-4 protects against oxidative stress and modulates iNOS expression through NF-kappa B translocation[J].Toxicol Appl Pharmacol,2008,230(2):187-196.
[22] Liu Q,Yin X,Li M,et al.Identification of potential crucial genes and pathways associated with vein graft restenosis based on gene expression analysis in experimental rabbits[J].Peer J,2018,16(6):e4704.