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(P<0.001)。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,P<0.05]。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(P<0.01)。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(P<0.01),LVDD和LVEF差异无统计学意义(P>0.05)。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(P<0.01)。PSSR基础
Objective The extracorporeal cardiac shock wave therapy（ CSWT） can promote angiogenesis in ischemic myocardium and improve myocardial perfusion, but its mechanisms remain to be clarified. This study aimed to explore the effects of CSWT on the endothelial progenitor cells（ EPCs）,vascular endothelial growth factor（ VEGF） and Interleukin-8（ IL-8） as well as its relieving effect on angina pectoris in patients with coronary heart disease. Methods After Dobutamine stress echocardiography（ DSE）and99 mTc-MIBI myocardial perfusion imaging（ MPI） at rest and under stress,25 patients with coronary heart disease underwent 9 threemonth cycles of CSWT. Before and after the treatment,we obtained the results of 6-min walk test,NYHA cardiac function grades,CCS angina pectoris classes,Seattle Angina Questionnaire（ SAQ） scores,doses of nitroglycerin administered,left ventricular diastolic diameter（ LVDD）,and left ventricular ejection fraction（ LVEF）. We evaluated myocardial perfusion and myocardial contractile function using MPI and the peak systolic strain rate（ PSSR） at rest and under stress,respectively. Results After CSWT,the numbers of EPCs and EPC-CFUs cultured in vitro were significantly increased as compared with the baseline（ 34. 52 ± 6. 58 vs 19. 56 ± 4. 28,P〈0.01; 12.44±2.66 vs 5. 04 ± 1. 90,P〈0.01）,and so was that of the circulating EPCs in the peripheral blood（ [904. 73 ± 94. 77] vs[815.68±101.08]/mL,P〈0.05）,the levels of VEGF and IL-8（ 155.29±23.6 vs 122.26±18.85,P〈0.01; 149.37±46.51 vs 21.86±5.96,P〈0.01）,the distance of 6-min walk（ P〈0.01）,NYHA cardiac function grades（ P〈0.01）,CCS angina pectoris classes（ P〈0.01）,SAQ scores（ P〈0.01）,doses of nitroglycerin administered（ P〈0.01）,and MPI scores at rest and under stress（ 2.16±0.16 vs1.04±0.19,P〈0.01; 1.40±0.16 vs 0.80±0.16,P〈0.01）,but no statistically significant differences were observed in LVDD and LVEF before and after treatment（ P〉0.05）. The PSSR sho
出处
《医学研究生学报》
CAS
北大核心
2017年第1期42-47,共6页
Journal of Medical Postgraduates
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)
关键词
体外心脏震波
内皮祖细胞
血管内皮生长因子
白细胞介素-8
临床疗效
Extracorporeal cardiac shock wave therapy
Endothelial progenitor cell
Vascular endothelial growth factor
Interleukin-8
Therapeutic efficacy
