经皮腔内冠脉介入术对冠脉循环中肾上腺髓质素及肿瘤坏死因子的影响

南方医科大学学报 ›› 2004, Vol. 24 ›› Issue (06): 636-638,645.

经皮腔内冠脉介入术对冠脉循环中肾上腺髓质素及肿瘤坏死因子的影响

刘海潮, 刘映峰, 李志樑, 吴宏超, 李公信, 叶文胜, 魏向荣, 陆青, 唐朝枢

第一军医大学珠江医院心内科, 广东广州, 510282

出版日期:2004-06-20 发布日期:2004-06-20
基金资助:
收稿日期:2004-2-13。
基金项目:国家重点基础研究发展项目(973)子课题(G2000056905)
作者简介:刘海潮(1976- ),女,第一军医大学在读硕士研究生,电话:020-61643597,E-mail:lhclht@vip.sina.com.

Effect of percutaneous intervention on adrenomedullin and tumor necrosis factor in the coronary circulation

LIU Hai-chao, LIU Ying-feng, LI Zhi-liang, WU Hong-chao, LI Gong-xin, YE Wen-sheng, WEI Xiang-rong, LU Qing, TANG Chao-shu

第一军医大学珠江医院心内科, 广东广州, 510282

Online:2004-06-20 Published:2004-06-20

摘要/Abstract

摘要： 目的探讨经皮腔内冠脉介入术对冠脉循环中肾上腺髓质素(ADM)及肿瘤坏死因子α(TNF-α)水平的影响。方法 33例冠心病患者分别于冠脉造影前后即刻、球囊扩张(PTCA)后即刻、支架置入后即刻、术后10 min采集冠状静脉窦血,同时采集股动脉血,采用放免法测定ADM、TNF-α浓度。结果冠脉造影前后ADM及TNF-α无明显变化(P>0.05);PTCA后即刻冠状窦内ADM和TNF-α明显升高(P<0.01);支架后即刻ADM有上升趋势(P>0.05);术后10 min ADM降至术前水平。结论冠脉造影对冠脉循环血管活性物质基本不影响;PTCA及支架术后冠脉循环中ADM和TNF-α升高,可能与球囊损伤内皮、支架对管壁的机械压迫及刺激有关,两者可能参与了PTCA及支架术后急性闭塞、再狭窄的调节。

Abstract: Objective To evaluate the effect of percutaneous intervention (PCI) on coronary circulation levels of adrenome-dullin (ADM) and tumor necrosis factor α(TNF-α) in patients with coronary heart disease (CHD). Methods Thirty-three CHD patients underwent percutaneous transluminal coronary angioplasty (PTCA) and stenting (altogether 48 stents were implanted). Blood samples were collected from the coronary sinus and femoral artery at the time points of immediately before and after angioplasty, immediately after PTCA or stenting, 10 min after procedures, respectively. Results The ADM and TNF-αlevels in the coronary sinus varied little after coronary angiography, but were elevated markedly following PTCA from the basal levels of 36.3±1.3 pg/ml to 28.9±1.9 pg/ml (P<0.01) and from 11.10±0.46 ng/ml to 8.84±0.37 ng/ml (P<0.01), respectively. Further increases of ADM and TNF-αlevels were detected immediately after stent deployment. ADM recovered to basal levels 10 min after completion of the procedures, while TNF-αunderwent further increase. Before the procedure, ADM and TNF-αlevels were higher in the coronary sinus than in the femoral artery (28.9±1.9 pg/ml vs 22.6±0.8 pg/ml, P<0.01; 8.84±0.37 ng/ml vs 7. 56±0.23 ng/ml, P<0.01, respectively), and their levels in the femoral artery did not undergo significant changes in response to the operations. Conclusion The coronary circulation levels of ADM and TNF-αincrease after PTCA and stenting but not after coronary angiography in CHD patients, which might be attributed to injuries by the procedures as well as the mechanical stimulation by the stent.

中图分类号:

R329.26

刘海潮, 刘映峰, 李志樑, 吴宏超, 李公信, 叶文胜, 魏向荣, 陆青, 唐朝枢. 经皮腔内冠脉介入术对冠脉循环中肾上腺髓质素及肿瘤坏死因子的影响[J]. 南方医科大学学报, 2004, 24(06): 636-638,645.

LIU Hai-chao, LIU Ying-feng, LI Zhi-liang, WU Hong-chao, LI Gong-xin, YE Wen-sheng, WEI Xiang-rong, LU Qing, TANG Chao-shu. Effect of percutaneous intervention on adrenomedullin and tumor necrosis factor in the coronary circulation[J]. Journal of Southern Medical University, 2004, 24(06): 636-638,645.

参考文献

[1] Kitamura K,Kangawa K,Kawamoto M,et al.Adrenomedullin:a novel hypotensive peptide isolated from human pheochromocytoma[J].Biochem Biophys Res Commun,1993,192(2):553-60.
[2] Tian Q,Zhao D,Tan DY,et al.Hypotensive effects and mechanisms of adrenomedullin(13-52)[J].ChinJHypertens,1994,2:13
[3] Kano H,KohNo M,Yasunari K,et al.Adrenomedullin as a novel antiproliferative factor of vascular smooth muscle cells [J].JHypertens,1996,14(2):209-13.
[4] Horio T,Kano H,Yoshihara F,et al.Adrenomedullin as a novel antimigration factor of vascular smooth muscle cells [J].Circ Res,1995,77(4):660-4.
[5] AgataJ,ZhangJJ,ChaoJ,et al.Adrenomedullin gene delivery inhibits neointima formation in rta artery after balloon angioplasty[J].Regul Pept,2003,112(1-3):115-20.
[6] 刘乃奎,陈光慧,王晓红,等.血管活性肽在大鼠血管再狭窄形成中的作用[J].中华医学杂志,2001,81(3):162-7.Liu NK,Chen GH,Wang XH,et al.Effects of vasoactive peptides on the development ofrestenosis[J].Natl MedJChin,2001,81(3):162-7.
[7] Coppock HA,Owji AA,Austin C,et al.Rat-2 fibroblasts express specific adrenomedullin receptors,but not calcitonin-gene-relatedpeptide receptors,which mediate increased intracellular cAMP and inhibit mitogen-activated protein kinase activity [J].BiochemJ,1999,338(Pt 1):15-22.
[8] Barker S,Lees DM,Wood EG,et al.Inhibitory effect of adrenomedullin on basal and tumour,necrosis factor alpha-stimulated endothelin-1 synthesis in bovine aortic endothelial cells is independent ofcyclicAMP [J].Biochem Pharmacol,2002,63 (2):149-56.
[9] Isumi Y,Shoji H,Sugo S,et al.Regulation ofadrenomedullin production in rat endothelial cells [J].Endocrinology,1998,139(3):838-46.
[10] Lang-Rollin I,SchurekJO,Lang RE,et al.Platelet-induced inhibition of adrenomedullin secretion[J].EurJPharmacol,2001,427(2):115-8.
[11] 孙宁玲,王伟民,李明,等.冠状动脉成形术对冠心病合并高血压患者血浆肾上腺髓质素和内皮素的影响[J].中华心血管病杂志,2001,29(4):210-2.Sun NL,Wang WM,Li M,et al.A change of adrenomedulium and endothlin-1 in patients with hypertension and coronary artery lesion[J].ChinJCardiol,2001,29(4):210-2.
[12] Kemal EM,Gene Y,Kiziltune A,et al.Increased plasma adrenomedullin in patients undergoing percutaneous transluminal coronary angioplasty[J].Swiss Med Wkly,2001,131(3-4):50-3.
[13] Hofbauer KH,Jensen BL,Kurtz A,et al.Tissue hypoxygenation activates the adrenomedullin system in vivo[J].AmJPhysiol Regul Integr Comp Physiol,2000,278(2):R513-9.
[14] Nakayama M,Takahashi K,Murakami O,et al.Induction of adrenomedullin by hypoxia in cultured human coronary artery endothelial cells[J].Peptides,1999,20(6):769-72.
[15] Yoshitomi Y,Nisbikimi T,Kojima S,et al.Plasma levels of adrenomedullin in patients with acute myocardial infarction[J].Clin Sci,1998,94(2):135-9.
[16] Horio T,Nisbikimi T,Yoshihara F,et al.Production and secretion of adrenomedullin in cultured rat cardiac myocytes and noumyocytes:Stimutation by IL-1β and TNF-α [J].Endocrinology,1998,139(11):4576-80.
[17] 曹静,张钧华,王晓红,等.肾上腺髓质素在心肌缺血再灌注病人血浆中的变化及其对心肌的保护作用[J].中华医学杂志,2000,80(4):261-4.CaoJ,ZhangJH,Wang XH,et al.Changes and cardiac protective effects of adrenomedullin during myocardial ischemia-reperfusion period[J].Natl MedJChin,2000,80(4):261-4.
[18] Sugo S,Minamino N,Shoji H,et al.Interleukin-1,tumor necrosis factor and lipopolysaccharide additively stimulate production of adrenomedullin in vascular smooth muscle cells [J].Biochem Biophys Res Commun,1995,207(1):25-32.