经皮冠状动脉介入治疗对冠心病合并左心功能不全患者VEGF、ADAMTS4及心功能的影响
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摘要
目的探讨经皮冠状动脉介入治疗对冠心病合并左心功能不全患者血管内皮生长因子(VEGF)、解聚蛋白样金属蛋白酶4(ADAMTS4)及心功能的影响。方法选取2017年4月—2018年2月收治的100例冠心病合并心功能不全患者作为观察组,均予以经皮冠状动脉介入治疗。并选取同期进行体检的健康者100例作为对照组。分别对2组的VEGF和ADAMTS4水平变化进行观察比较,并对观察组手术前后的各项心功能指标、纽约心脏病协会(NYHA)分级以及并发症发生情况进行比较。结果观察组术前的VEGF和ADAMTS4水平高于对照组(P<0.05);观察组术后即刻的VEGF和ADAMTS4水平较术前升高(P<0.05);观察组术后2 d和7 d的VEGF水平较术前降低(P<0.01)。观察组术后6个月的左心室收缩末期内径和左心室舒张末期内径较术前降低,左心室短轴缩短率和左心室射血分数水平较术前升高,NYHA分级优于术前(P<0.01)。手术期间观察组未见严重并发症。结论经皮冠状动脉介入治疗能够有效改善冠心病合并左心功能不全患者的心功能,并促进患者血运的恢复。
Objective To investigate effects of percutaneous coronary artery interventional therapy on vascular endothelial growth factor(VEGF), a disintegrin and metalloproteinase with thrombospondin motifs 4(ADAMTS4) and cardiac function in patients with coronary heart disease complicated by left ventricular dysfunction. Methods A total of 100 patients with coronary heart disease complicated by cardiac insufficiency admitted during April 2017 and February 2018 were selected as observation group, and the patients were treated with percutaneous coronary artery interventional therapy, and other 100 healthy people taking physical examinations at the same period were selected as control group. Changes of VEGF and ADAMTS4 levels were observed and compared in two groups, and cardiac function indexes, New York Heart Association(NYHA) classification and incidence rate of complications before and after operation were compared in observation group. Results Levels of preoperative VEGF and ADAMTS4 in observation group were significantly higher than those in control group(P<0.05). Levels of VEGF and ADAMTS4 at the time of operation ending were significantly higher than those before surgery in observation group(P<0.05). VEGF levels in the 2~(nd) and 7~(th) d after operation were significantly lower than that before operation in observation group(P<0.01). In observation group in the 6~(th) month after operation, values of left ventricular end-systolic dimension(LVDs) and left ventricular end diastolic dimension(LVDd) were significantly lower, while values of left ventricular shortening fraction(SF) and left ventricular ejection fraction(LVEF) were significantly higher than those before operation, and NYHA classification was better than that before operation(P<0.01). No serious complications were observed during operation in observation group. Conclusion Percutaneous coronary artery interventional therapy may effectively improve cardiac function and promote recovery of blood supply of patients with coronary heart disease complicated by left ventricular dysfunction.
Objective To investigate effects of percutaneous coronary artery interventional therapy on vascular endothelial growth factor(VEGF), a disintegrin and metalloproteinase with thrombospondin motifs 4(ADAMTS4) and cardiac function in patients with coronary heart disease complicated by left ventricular dysfunction. Methods A total of 100 patients with coronary heart disease complicated by cardiac insufficiency admitted during April 2017 and February 2018 were selected as observation group, and the patients were treated with percutaneous coronary artery interventional therapy, and other 100 healthy people taking physical examinations at the same period were selected as control group. Changes of VEGF and ADAMTS4 levels were observed and compared in two groups, and cardiac function indexes, New York Heart Association(NYHA) classification and incidence rate of complications before and after operation were compared in observation group. Results Levels of preoperative VEGF and ADAMTS4 in observation group were significantly higher than those in control group(P<0.05). Levels of VEGF and ADAMTS4 at the time of operation ending were significantly higher than those before surgery in observation group(P<0.05). VEGF levels in the 2~(nd) and 7~(th) d after operation were significantly lower than that before operation in observation group(P<0.01). In observation group in the 6~(th) month after operation, values of left ventricular end-systolic dimension(LVDs) and left ventricular end diastolic dimension(LVDd) were significantly lower, while values of left ventricular shortening fraction(SF) and left ventricular ejection fraction(LVEF) were significantly higher than those before operation, and NYHA classification was better than that before operation(P<0.01). No serious complications were observed during operation in observation group. Conclusion Percutaneous coronary artery interventional therapy may effectively improve cardiac function and promote recovery of blood supply of patients with coronary heart disease complicated by left ventricular dysfunction.
引文
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[13] Giordano A, Ferraro P, Corcione N, et al. Impact of sex on the early and long-term outlook of patients undergoing carotid artery stenting with a single embolic protection device-stent combo[J].Edorium J Cardiol, 2015,2:9-15.
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[15] 杜成林,侯铮.高龄急性心肌梗死患者经桡动脉途径直接PCI治疗的临床效果观察[J].血管与腔内血管外科杂志,2016,2(5):412-414,419.
[16] Osadnik T, Lekston A, Bujak K, et al. The Relationship between VEGFA and TGFB1 polymorphisms and target lesion revascularization after elective percutaneous coronary intervention[J].Dis Markers, 2017,2017:8165219.
[17] 吴晴晴,华琦,薛淞,等.白细胞计数与急性ST段抬高型心肌梗死病人直接经皮冠状动脉介入术中无复流的关系[J].首都医科大学学报,2017,38(3):372-376.
[18] 沈志明,刘衬云,陈军,等.血流储备分数在经皮冠状动脉介入治疗老年冠心病患者中的作用[J].中国老年学杂志,2012,32(24):5378-5379.
[19] 许晓琼,杨德辉,王湘川,等.经皮冠状动脉介入治疗对冠心病患者心率变异的影响[J].华北国防医药,2009,21(1):30-31.
[20] Ikhapoh I A, Pelham C J, Agrawal D K. Atherogenic cytokines regulate VEGF-A-induced differentiation of bone marrow-derived mesenchymal stem cells into endothelial cells[J].Stem Cells Int, 2015,2015:498328.
[21] 彭描宇.经皮冠状动脉介入治疗老年冠心病的疗效观察[J].中国医学创新,2011,8(28):32-33.
[22] 李洁荣,吕云,高彦.经桡动脉和股动脉途径行经皮冠状动脉介入治疗高龄冠心病的疗效比较[J].中西医结合心脑血管病杂志,2016,14(8):891-893.
[2] 巩贵宏,朱豪,李红梅,等.经皮冠状动脉介入治疗对冠心病合并左心功能不全患者心功能影响的临床观察[J].中国医药指南,2015,13(11):124-125.
[3] Bekler A, Gazi E, Yilmaz M, et al. Could elevated platelet-lymphocyte ratio predict left ventricular systolic dysfunction in patients with non-ST elevated acute coronary syndrome?[J].Anatol J Cardiol, 2015,15(5):385-390.
[4] 李中昕.经皮冠状动脉介入治疗对冠心病合并左心功能不全患者心功能的影响[J].中国实用医药,2016,11(18):182-183.
[5] 李宁.经皮冠状动脉介入治疗对冠心病合并左心功能不全患者心功能的临床效果评价[J].保健医学研究与实践,2015,12(6):72-73.
[6] Ip J E, Wu Y, Huang J, et al. Mesenchymal stem cells use integrin β1 not CXC chemokine receptor 4 for myocardial migration and engraftment[J].Mol Biol Cell, 2007,18(8):2873-2882.
[7] Alrefai M T, Murali D, Paul A, et al. Cardiac tissue engineering and regeneration using cell-based therapy[J].Stem Cells Cloning, 2015,8:81-101.
[8] 郭成军,吕树铮,阎方明,等.经皮冠状动脉介入治疗防治冠心病无心肌梗死患者的电风暴[J].中华心血管病杂志,2005,33(9):806-809.
[9] 韩雅玲,荆全民,王守力,等.经皮冠状动脉介入治疗冠心病10225例经验总结[J].中国实用内科杂志,2007,27(23):1832-1835.
[10] Gao M, Yao Q, Liu Y, et al. Association between mobilization of circulating endothelial progenitor cells and time or degree of injury from angioplasty in patients with exertional angina: a prospective study[J].Exp Ther Med, 2015,10(2):809-815.
[11] 罗燕华,洪蝶玟,蔡志雄,等.行为干预对行经皮冠状动脉介入治疗的绝经期冠心病合并糖尿病患者的影响[J].中国医科大学学报,2013,42(5):476-477.
[12] 王晓红,赵淑清.经皮冠状动脉介入治疗对冠心病患者内皮功能、纤溶活性及炎症指标的影响[J].中华心血管病杂志,2004,32(5):453-454.
[13] Giordano A, Ferraro P, Corcione N, et al. Impact of sex on the early and long-term outlook of patients undergoing carotid artery stenting with a single embolic protection device-stent combo[J].Edorium J Cardiol, 2015,2:9-15.
[14] 赵亮,吴先明,何辉,等.经皮冠状动脉介入治疗对冠心病合并左心功能不全患者心功能的影响[J].实用心脑肺血管病杂志,2014,22(12):45-47.
[15] 杜成林,侯铮.高龄急性心肌梗死患者经桡动脉途径直接PCI治疗的临床效果观察[J].血管与腔内血管外科杂志,2016,2(5):412-414,419.
[16] Osadnik T, Lekston A, Bujak K, et al. The Relationship between VEGFA and TGFB1 polymorphisms and target lesion revascularization after elective percutaneous coronary intervention[J].Dis Markers, 2017,2017:8165219.
[17] 吴晴晴,华琦,薛淞,等.白细胞计数与急性ST段抬高型心肌梗死病人直接经皮冠状动脉介入术中无复流的关系[J].首都医科大学学报,2017,38(3):372-376.
[18] 沈志明,刘衬云,陈军,等.血流储备分数在经皮冠状动脉介入治疗老年冠心病患者中的作用[J].中国老年学杂志,2012,32(24):5378-5379.
[19] 许晓琼,杨德辉,王湘川,等.经皮冠状动脉介入治疗对冠心病患者心率变异的影响[J].华北国防医药,2009,21(1):30-31.
[20] Ikhapoh I A, Pelham C J, Agrawal D K. Atherogenic cytokines regulate VEGF-A-induced differentiation of bone marrow-derived mesenchymal stem cells into endothelial cells[J].Stem Cells Int, 2015,2015:498328.
[21] 彭描宇.经皮冠状动脉介入治疗老年冠心病的疗效观察[J].中国医学创新,2011,8(28):32-33.
[22] 李洁荣,吕云,高彦.经桡动脉和股动脉途径行经皮冠状动脉介入治疗高龄冠心病的疗效比较[J].中西医结合心脑血管病杂志,2016,14(8):891-893.