CAJ | 학술논문

目的比较老年与年轻冠状动脉粥样硬化性心脏病(冠心病)患者桡动脉形态学差异及内皮型一氧化氮合酶(eNOS)的表达.方法 2008年2月至2009年6月219例应用自体桡动脉行冠状动脉旁路移植术(CABG),其中老年组(≥70岁)57例,年轻组(≤60岁)64例.术前常规行改良Allen试验,阳性患者再以Doppler超声复检.两组患者桡动脉均行HE染色,观测管腔狭窄程度(LN)及内膜/中膜比(IMR);通过免疫荧光染色及Western blot观察eNOS在桡动脉中的定位及表达水平.结果两组患者桡动脉内膜增生均为轻到中度,中膜未见明显钙化.老年组LN为(22±6)%,年轻组为(23±6)%;老年组IMR为0.36±0.21,年轻组为0.42±0.19;两者组间差异均无统计学意义(P＞0.05).eNOS在桡动脉内膜、中膜均有表达,以中膜平滑肌层为主,相对积分光密度值分析显示老年组桡动脉管壁eNOS表达含量为1.21±0.13,年轻组为1.25±0.12,组间差异无统计学意义(P＞0.05).结论经过改良Allen实验及Doppler超声筛选后,老年冠心病患者桡动脉的质量及功能与年轻患者相近,应用于CABG有望获得较高的远期通畅率.
목적 비교노년여년경관상동맥죽양경화성심장병(관심병)환자뇨동맥형태학차이급내피형일양화담합매(eNOS)적표체.방법 2008년2월지2009년6월219례응용자체뇨동맥행관상동맥방로이식술(CABG),기중노년조(≥70세)57례,년경조(≤60세)64례.술전상규행개량Allen시험,양성환자재이Doppler초성복검.량조환자뇨동맥균행HE염색,관측관강협착정도(LN)급내막/중막비(IMR);통과면역형광염색급Western blot관찰eNOS재뇨동맥중적정위급표체수평.결과 량조환자뇨동맥내막증생균위경도중도,중막미견명현개화.노년조LN위(22±6)%,년경조위(23±6)%;노년조IMR위0.36±0.21,년경조위0.42±0.19;량자조간차이균무통계학의의(P＞0.05).eNOS재뇨동맥내막、중막균유표체,이중막평활기층위주,상대적분광밀도치분석현시노년조뇨동맥관벽eNOS표체함량위1.21±0.13,년경조위1.25±0.12,조간차이무통계학의의(P＞0.05).결론경과개량Allen실험급Doppler초성사선후,노년관심병환자뇨동맥적질량급공능여년경환자상근,응용우CABG유망획득교고적원기통창솔.
Objective To compare the morphometry and endothelial nitric oxide synthase (eNOS) expression of radial artery ( RA) between young and elderly patients with coronary atherosclerotic heart disease. Methods From February 2008 to June 2009, 219 patients underwent coronary artery bypass grafting (CABG) with autologous RA, 57 patients aged beyond 70 years and 64 patients aged under 60 years. Before RA was harvested, a modified Allen test was routinely performed. If positive, RA would be further evaluated with Doppler ultrasound examination. In both groups RA was collected for HE staining to evaluate percentage of luminal narrowing ( LN ) and relationship between intima and media width at maximum intimal thickness (IMR). Immunofluorescence and Western blot were used to investigate the location and expression level of eNOS within the wall of RA. Results Morphometry of RA in both young and elderly patients represented mild or moderate intimal hyperplasia, and medial calcification was not found. LN in elderly patients was(22±6)%,while in young patients,it was(23±6)%.IMR in elderly patients was 0.36±0.21.while in young patients,it was 0.42±0.19.There was no significant difierence in both LN and IMR between two groups(P＞0.05).Immunofluorescence indicated RA in both groups revealed a high expression of eNOS in intima and media.particularly in the smooth muscle of media.The values of relative integrated optical density in elderly patients was 1.21±0.13,while in young patients,it was 1.25±0.12 Also there was no significant difference in the expression level of eNOS within the wall of RA(P＞0.05).Conclusion 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 hish patency in long term.