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  本文選題：體外心臟震波 + 內(nèi)皮祖細胞��； 參考：《醫(yī)學(xué)研究生學(xué)報》2017年01期

【摘要】：目的體外心臟震波(CSWT)能夠促進缺血心肌血管新生,改善心功能,但其機制尚未明確。文中旨在探討CSWT對冠心病患者外周血內(nèi)皮祖細胞(EPCs)、血管內(nèi)皮生長因子(VEGF)和IL-8的影響及其對緩解患者心絞痛效果的評價。方法回顧性分析昆明醫(yī)學(xué)院第一附屬醫(yī)院心內(nèi)科2007年9月至2010年12月住院冠心病患者25例,應(yīng)用震波治療儀行CSWT,治療前使用多巴酚丁胺負(fù)荷超聲心動圖和基礎(chǔ)及負(fù)荷狀態(tài)下99mTc-甲氧基異丁基異腈(99mTc-MIBI)心肌灌注顯像識別并定位缺血/存活心肌。以3個月為1個震波治療周期,共行9次CSWT治療。所有患者均在治療前后采集外周血單個核細胞培養(yǎng)成EPCs,觀察其形態(tài)和數(shù)量。使用激光共聚焦顯微鏡鑒定EPCs;流式細胞術(shù)直接檢測外周血EPCs數(shù)量;ELISA法檢測治療前后外周血細胞因子VEGF、IL-8的表達水平。另外,在治療前后行6 min步行距離、NYHA心功能分級、CCS心絞痛分級、SAQ評分、硝酸甘油用量臨床指標(biāo)評估;測量左室舒張末內(nèi)徑(LVDD)和左室射血分?jǐn)?shù)(LVEF);采用靜息及負(fù)荷狀態(tài)下收縮期峰值應(yīng)變率(PSSR)和心肌灌注顯像(MPI)評價局部心肌收縮功能和血流灌注。結(jié)果 CSWT治療后,體外培養(yǎng)的EPCs數(shù)量(34.52±6.58)和細胞集落形成數(shù)(12.44±2.66)分別較治療前(19.56±4.28、5.04±1.90)明顯增多(P0.001)。流式細胞儀檢測外周血循環(huán)中EPCs數(shù)量較治療前亦明顯增多[(904.73±94.77)/m L vs(815.68±101.08)/m L,P0.05]。治療后外周血細胞因子VEGF[(155.29±23.6)pg/m L]、IL-8[(149.37±46.51)pg/m L]均較治療前(122.26±18.85、21.86±5.96)pg/m L明顯增加(P0.01)。與治療前相比,治療后患者6 min步行距離、NYHA心功能分級、CCS心絞痛分級、SAQ評分、硝酸甘油用量均得到明顯改善(P0.01),LVDD和LVEF差異無統(tǒng)計學(xué)意義(P0.05)。治療后MPI在靜息(2.16±0.16)和負(fù)荷(1.40±0.16)狀態(tài)下分別較治療前(1.04±0.19、0.80±0.16)明顯增加(P0.01)。PSSR基礎(chǔ)狀態(tài)下治療前后差異無統(tǒng)計學(xué)意義(P0.05),負(fù)荷狀態(tài)下明顯增強[(2.02±1.00)vs(1.35±0.66),P0.01]。結(jié)論 CSWT能夠提高冠心病患者外周血VEGF、IL-8的表達,促進EPCs的功能,在緩解患者心絞痛癥狀、改善心功能、提高運動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 鹵6.58) and the number of colony formation was 12.44 鹵2.66), which was significantly higher than that before treatment (19.56 鹵4.285.04 鹵1.90). The number of EPCs in peripheral blood circulation was also significantly increased by flow cytometry [904.73 鹵94.77 min / mL vs(815.68 鹵101.08 渭 m / mL P 0.05]. The peripheral blood cytokine VEGF [155.29 鹵23.6)pg/m L] IL-8 [149.37 鹵46.51)pg/m L] was significantly higher than that before treatment (122.26 鹵18.85 鹵21.86 鹵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 鹵0.16) and load (1.40 鹵0.16) than that before treatment (1.04 鹵0.19 鹵0.80 鹵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 鹵1.00)vs(1.35 鹵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.
【作者單位】： 昆明醫(yī)科大學(xué)第一附屬醫(yī)院心內(nèi)科;
【基金】：國家自然科學(xué)基金(81260027) 云南省科技計劃項目-省應(yīng)用基礎(chǔ)研究(昆醫(yī)聯(lián)合專項)(2014FZ023)
【分類號】：R541.4

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