CAJ | 학술논문

目的：构建膨体聚四氟乙烯（expanded polytetrafluoroethylene，ePTFE）人工血管置换杂种犬肾动脉平面下腹主动脉的血管重建手术模型。探讨总剂量28Gy的体外分割放射治疗影响重建术后人工血管内膜增生的机制。方法健康杂种犬12只，采用数字表法随机均分成放疗组和对照组。均先行肾下腹主动脉段的人工血管置换重建术。放疗组于术后2周后对标记区血管行总剂量28Gy的体外放疗。对照组则不放疗。重建术后5周观察比较两组移植术后的人工血管新生内膜的增生情况，Skp2、p27 kip1和增生细胞核抗原（proliferating cell nuclear antigen，PCNA）的蛋白和mRNA的表达情况。结果放疗组的人工血管吻合口内膜增生程度明显比对照组降低（P＜0.01）。放疗组的Skp2、PCNA的蛋白表达及mRNA表达较对照组明显减低，而p27 kip1的mRNA表达较对照组明显增加（P＜0.01）。结论术后体外分割放疗（28Gy）在短期内可以通过抑制血管平滑肌细胞（vascular smooth muscle cell，VSMC）的增生，从而抑制重建术后的人工血管的内膜增生。
목적：구건팽체취사불을희（expanded polytetrafluoroethylene，ePTFE）인공혈관치환잡충견신동맥평면하복주동맥적혈관중건수술모형。탐토총제량28Gy적체외분할방사치료영향중건술후인공혈관내막증생적궤제。방법건강잡충견12지，채용수자표법수궤균분성방료조화대조조。균선행신하복주동맥단적인공혈관치환중건술。방료조우술후2주후대표기구혈관행총제량28Gy적체외방료。대조조칙불방료。중건술후5주관찰비교량조이식술후적인공혈관신생내막적증생정황，Skp2、p27 kip1화증생세포핵항원（proliferating cell nuclear antigen，PCNA）적단백화mRNA적표체정황。결과방료조적인공혈관문합구내막증생정도명현비대조조강저（P＜0.01）。방료조적Skp2、PCNA적단백표체급mRNA표체교대조조명현감저，이p27 kip1적mRNA표체교대조조명현증가（P＜0.01）。결론술후체외분할방료（28Gy）재단기내가이통과억제혈관평활기세포（vascular smooth muscle cell，VSMC）적증생，종이억제중건술후적인공혈관적내막증생。
Objective To study the effect of postoperative fractionated X-ray radiotherapy,at a total dose of 28 Gy,on neointimal formation and strive to further elucidate the mechanisms of neointimal hyperplasia in the abdominal expanded polytetrafluoroethylene (ePTFE)prosthetic vascular graft.Methods The subrenal abdominal aortas of 1 2 mongrel dogs were replaced with an ePTFE graft.The dogs were randomly divided into either a radiotherapy group or a non-radiotherapy control group.Grafts were harvested at five weeks after surgery for comparing the thickness of neointimal formation and the expression of PCNA,S phase kinase associated protein 2 (Skp2)and p27 kip1 in the two groups.Results We observed that the graft neointimal and anastomotic vessel wall of the radiotherapy group were significantly thinner than those of the control group (P<0.01 ).The mRNA and the protein expression of p27 kip1 was elevated in the neointimal area after irradiation (P<0.01 ).The mRNA and the protein expression of PCNA and Skp2 were significantly down-regulated in the radiotherapy group (P<0.01 ).Conclusion Postoperative fractionated radiotherapy(28 Gy)after an ePTFE graft replacement of the abdominal aorta suppressed the development of neointimal hyperplasia and the proliferation of vascular smooth muscle cell (VSMC)in the graft in the short term.