伴有糖尿病的老年冠状动脉粥样硬化性心脏病患者桡动脉超微结构研究

目的 研究年龄及糖尿病因素对冠状动脉粥样硬化性心脏病患者桡动脉超微结构的影响.方法 2009年6月至2010年12月我院应用自体桡动脉行冠状动脉旁路移植术(CABG)64例,分为4组:老年非糖尿病组14例,其中男性9例,女性5例,平均年龄(70±4)岁;老年糖尿病组18例,其中男性11例,女性7例,平均年龄(68±5)岁;年轻非糖尿病组20例,其中男性13例,女性7例,平均年龄(53±5)岁;年轻糖尿病组12例,其中男性7例,女性5例,平均年龄(51±6)岁.用电镜观察、比较4组患者桡动脉内膜及中膜的超微结构.结果 扫描电镜下4组患者内皮细胞脱落率差异有统计学意义(X2=18.082,P=0.000);两两比较发现,老年糖尿病组与老年非糖尿病组、年轻糖尿病组与年轻非糖尿病组内皮细胞脱落率差异有统计学意义;老年糖尿病组与年轻糖尿病组、老年非糖尿病组与年轻非糖尿病组之间差异无统计学意义.透射电镜下观察糖尿病组患者桡动脉可见平滑肌细胞性泡沫细胞的出现以及平滑肌细胞向内膜下迁移倾向.对样本内皮细胞的结构、组织水肿的程度、内皮细胞中线粒体的形态学改变3个方面进行半定量评分,年轻非糖尿病组总评分低于年轻糖尿病组(1.32±0.20比4.38±0.30),老年非糖尿病组总评分低于老年糖尿病组(1.43 ±0.20比4.67±0.30);四组总评分采用析因设计方差分析,年龄因素主效应无统计学意义(F=1.24,P=0.270),糖尿病因素有统计学意义(F=41.22,P=0.000),年龄和糖尿病交互作用无统计学意义(F=1.05,P=0.309).结论 经过改良Allen实验及多普勒超声筛选后,不伴糖尿病的老年人与年轻人桡动脉质量相近,而糖尿病患者桡动脉质量明显差于非糖尿病患者.

Comparative study on the ultrastructure of radial artery in elderly patients underwent coronary artery bypass grafting with diabetes mellitus

Objective To explore the impact of age and diabetes mellitus (DM) on the ultrastructure of radial artery (RA).Methods From June 2009 to December 2010,64 patients underwent coronary artery bypass grafting (CABG) with autologous RA:14 patients aged beyond 65 years without DM [9 male patients and 5 female patients,age (70 ±4) years] and 18 patients aged beyond 65 years with DM [ 11 male patients and 7 female patients,age (68 ±5) years],20 patients aged under 60 years without DM [ 13 male patients and 7 female patients,age (53 ±5) years] and 12 patients aged under 60 years with DM [7 male patients and 5 female patients,age (51 ±6) years].Four groups were subjected to routine electron microscopic examination and transmission electron microscopic examination.Results There were significant differences in percentage of endothelial denudation among four groups according to scanning electron microscopic evaluation( x2 =18.082,P =0.000).To compare with each other,there were significant differences between DM elderly patients and non-DM elderly patients,also between DM young patients and non-DM young patients according to scanning electron microscopic evaluation.There were no significant differences between DM elderly patients and DM young patients,also between non-DM elderly patients and non-DM young patients.Foam cells and the tendency of smooth muscle cells moving to intima could be visualized in DM patients according to transmission electron microscope.According to semiquantitative electron microscopic evaluation,non-DM young patients got the lower total scores than DM young patients ( 1.32 ± 0.20 vs.4.38 ± 0.30 ) while non-DM elderly patients got the lower total scores than DM elderly patients ( 1.43 ± 0.20 vs.4.67 ± 0.30).According to factorial design,there were significant differences between DM patients and non-DM patients ( F =41.22,P =0.000).There were no differences between elderly patients and young patients ( F =1.24,P =0.270 ).There is no interaction ( F =1.05,P =0.309 )between age and DM.Conclusions After preoperative assessment with modified Allen's test and Doppler analysis,RA used as graft in the elderly has similar quality and function with young patients,and it may lead to a high patency in long term.However,the quality of RA in patients with DM is in bad condition,and further research on patency needs to be done.