冠状动脉介入治疗促进血管内皮素I和血管紧张素Ⅱ的释放

目的 血管内皮损伤在经皮冠状动脉腔内成形（PTCA）后的急性与慢性合并症的发生发展中起着重要的作用。本探讨PTCA术对血管损伤和缩血管物质的影响。方法 44例单纯左冠状动脉前降支（LAD）狭窄的患，被随即分配到单纯球囊扩张（BA）组（11例），血管内放射治疗组（VBT，14例）及支架组（19例）。于PTCA术前及术后即刻，术后4h和24h从冠状窦取血，分别测定内皮素1（ET－1），血管紧张素Ⅱ（ANGⅡ）及vW因子（vWF)。7例单纯行冠状动脉造影的患作为对照组。结果 所有PTCA患术后即刻ET－1水平显增高，而ANGⅡ及vWF水平在PTCA术后4h开始明显增高。BA组、VBT组及支架组间上述指标无明显差异。结论 冠状窦血中ET－1及ANGⅡ、vWF水平的改变反应了PTCA术对血管损伤的程度。

Release of endothelin 1 and angiotensin II induced by percutaneous transluminal coronary angioplasty

Aim Endothelial dysfunction plays critical roles in acute and chronic complications after percutaneous transluminal coronary angioplasty (PTCA). Coronary endothelial injury and the release of vasoactive substances induced by PTCA were investigated. Methods Forty-four patients with ischemic heart disease who underwent elective PTCA to isolated stenotic lesions in left coronary arteries were examined. Eleven patients received balloon angioplasty (BA), fourteen percutaneous intravascular brachtheraphy (VBT), and nineteen stent implantation. Blood samples were drawn from the coronary sinus immediately before and 4 h and 24 h after PTCA. Levels of plasma endothelin 1 (ET-1), angiotensin (ANG) Ⅱ, von Willebrand factor (vWF), and thrombomodulin (TM) were measured. Seven subjects who underwent diagnostic coronary angiopgraphy (CAG) were used as control group. Results In all patients, ET-1 levels in the coronary sinus blood significantly increased immediately after PTCA. ANG Ⅱ levels and vWF activity showed significantly increased immmediately 4 h after PTCA. Changes in levels of these markers were similar among the BA, VBT and stent groups. TM levels were elevated in all groups of patients, including those simply undergoing diagnostic CAG. Conclusion Changes in ET-1, ANG Ⅱ and vWF levels in the coronary sinus reflect coronary endothelial injury induced by PTCA.