本文選題：射頻球囊血管成形術(shù)　切入點(diǎn)：動脈重構(gòu)　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:我們設(shè)計(jì)研發(fā)了一種新型的溫控式血管內(nèi)射頻消融球囊,采用縱向線形式消融增生的動脈內(nèi)膜,探究射頻球囊血管成形術(shù)對動脈粥樣硬化斑塊影響、對動脈的重構(gòu)作用及可能的機(jī)制,為治療動脈粥樣硬化提供一種新的方法。方法:通過高脂喂養(yǎng)聯(lián)合球囊損傷動脈內(nèi)膜方法建立兔腹主動脈動脈粥樣硬化模型,于第12周末隨機(jī)處死兩只行病理組織學(xué)檢查,確認(rèn)動脈粥樣硬化模型建立成功。然后分別應(yīng)用射頻球囊及普通球囊對家兔腹主動脈行血管成形術(shù),術(shù)后喂養(yǎng)正常飼料,并于術(shù)后1小時(shí)、7天、14天、28天四個(gè)時(shí)間點(diǎn)處死動物,取相應(yīng)腹主動脈標(biāo)本行病理組織學(xué)及免疫組織化學(xué)檢查;比較7天、14天、28天兩組管腔橫截面積、內(nèi)膜面積、中膜面積、內(nèi)膜面積與中膜面積比值、管腔橫截面積與血管外壁面積比值等管腔形態(tài)學(xué)指標(biāo)及管壁TGF-β1、MMP-2、MMP-9蛋白的表達(dá)是否有差異及隨時(shí)間變化情況,探討射頻球囊血管成形術(shù)對粥樣硬化動脈組織形態(tài)學(xué)的影響及可能的機(jī)制。結(jié)果:(1)球囊損傷動脈內(nèi)膜聯(lián)合高脂飼料喂養(yǎng)12周末,可見整個(gè)腹主動脈外觀呈灰白色,病理檢查,可見動脈內(nèi)膜明顯增生,表面有纖維組織覆蓋,構(gòu)成纖維帽,纖維帽下可見大量炎性細(xì)胞及泡沫細(xì)胞,中膜可見彈力纖維崩解、斷裂,平滑肌細(xì)胞排列紊亂,確認(rèn)兔腹主動脈動脈粥樣硬化模型建立成功。(2)射頻球囊擴(kuò)張組與普通球囊擴(kuò)張組相比,能顯著增加管腔內(nèi)徑,減少內(nèi)膜及中膜面積,管壁變薄,對管腔重構(gòu)作用明顯,并且射頻功率越大,對管腔的擴(kuò)張作用越顯著。(3)7天、14天、28天,射頻球囊擴(kuò)張組可見射頻消融部位出現(xiàn)局部纖維化,內(nèi)膜炎性細(xì)胞及泡沫細(xì)胞減少,甚至消失,中膜平滑肌細(xì)胞壞死,彈力纖維變性、拉伸變直。(4)功率較大時(shí),管壁出現(xiàn)全層透壁壞死,發(fā)生管腔全層纖維化,內(nèi)膜可見炎性細(xì)胞浸潤。(5)1小時(shí),兩組TGF-β1、MMP-2、MMP-9蛋白表達(dá)未見明顯差異;7天、14天、28天,消融擴(kuò)張部位表達(dá)明顯增加,內(nèi)膜全層高表達(dá)TGF-β1、MMP-2、MMP-9蛋白。結(jié)論:1.射頻球囊血管成形術(shù)可顯著增加管腔面積,可能與減少內(nèi)膜及中膜面積,使管壁變薄有關(guān)。2.射頻消融部位出現(xiàn)纖維化,內(nèi)膜炎性細(xì)胞及泡沫細(xì)胞減少、消失,中膜平滑肌細(xì)胞壞死,彈力纖維變性、拉伸,增加斑塊穩(wěn)定性。3.射頻熱損傷可使消融部位TGF-β1、MMP-2、MMP-9表達(dá)增加。4.射頻能量較高時(shí),使整個(gè)管腔出現(xiàn)透壁全層壞死,膠原纖維增生,管壁彈性消失,中期可見內(nèi)膜出現(xiàn)炎性細(xì)胞浸潤。
[Abstract]:Objective: to investigate the effect of radiofrequency balloon ablation (RFCA) on atherosclerotic plaques. The effect of arterial remodeling and its possible mechanism provide a new method for the treatment of atherosclerosis. Methods: a rabbit model of abdominal aortic atherosclerosis was established by high-fat feeding combined with balloon injury of artery intima. At the end of the 12th week, two rabbits were randomly killed for histopathological examination, which confirmed that the atherosclerosis model was established successfully, and then the rabbit abdominal aorta was treated with radiofrequency balloon and ordinary balloon respectively, and fed with normal diet after operation. The animals were killed at 4 time points, 1 hour and 14 days after operation, and the corresponding abdominal aorta specimens were taken for histopathological and immunohistochemical examination, and the cross sectional area of lumen, intimal area and middle membrane area were compared between the two groups on day 7 and day 14 and day 28, respectively. The ratio of intimal area to middle membrane area, the ratio of lumen cross-sectional area to vascular outer wall area, and the expression of TGF- 尾 _ 1MMP _ 2 / MMP-9 protein were different and varied with time. To investigate the effect of radiofrequency balloon angioplasty on the histomorphology of atherosclerotic artery and its possible mechanism. Results the whole abdominal aorta was grayish white at 12 weeks after balloon injury and fed with high fat diet. The intima of the artery obviously proliferated, the surface was covered with fibrous tissue, forming a fibrous cap, a large number of inflammatory cells and foam cells could be seen under the fibrous cap, and elastic fibers could be disintegrated, broken down, and smooth muscle cells arranged in disorder under the fibrous cap. It was confirmed that compared with the normal balloon dilatation group, the radiofrequency balloon dilatation group could significantly increase the diameter of the lumen, decrease the area of the intima and the middle membrane, and thin the wall of the rabbit abdominal aorta. The radiofrequency balloon dilatation group had a significant effect on the remodeling of the lumen. Moreover, the larger the RF power, the more significant the dilatation of the lumen was. In the radiofrequency balloon dilatation group, the local fibrosis appeared in the radiofrequency ablation site, and the inflammatory cells and foam cells in the endometrium decreased or even disappeared in the radiofrequency balloon dilatation group. When the power of medial smooth muscle cell necrosis, elastic fiber degeneration and stretch straightening is high, there is necrosis of the whole layer through the wall, fibrosis in the whole layer of the lumen, and inflammatory cell infiltration in the intima for 1 hour. There was no significant difference between the two groups in the expression of TGF- 尾 1, MMP-2 and MMP-9. The expression of TGF- 尾 1, MMP-2, MMP-9 and MMP-9 in the whole intima was significantly increased after 14 days and 28 days. Conclusion: 1. Radiofrequency balloon angioplasty can significantly increase the lumen area. It may be related to reducing the area of intima and media and thinning the wall of the tube. 2. Fibrosis occurs in the site of radiofrequency ablation, the inflammatory cells and foam cells of the intima decrease and disappear, the smooth muscle cells of the media are necrosed, the elastic fibers denaturation and stretch, Increase plaque stability .3. radiofrequency thermal injury can increase the expression of TGF- 尾 _ 1MMP _ 2 and MMP-9 in ablation site .4.When radiofrequency energy is high, the whole lumen will be necrosed, collagen fiber will proliferate, wall elasticity will disappear, and inflammatory cell infiltration can be seen in the middle stage.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R543.5

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