CAJ | 학술논문

目的：探讨血管动脉粥样硬化及血管成形术（PTA）后血管组织结构的改变以及血脂、脂蛋白（a）[LP（a）]和肿瘤坏死因子‐α（TNF‐α）在这一过程变化的意义。方法采用30只高脂喂养新西兰兔为实验组，10只普通饲料喂养的纯种新西兰兔作为对照组。分别于实验前、喂养2周和PTA术后1、2、3月行血液生化检查，常规生化法检测总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白（HDL‐C）浓度，低密度脂蛋白（LDL‐C）浓度，并分批取兔主动脉血管作组织病理学检查。使用多元Logistic回归分析动脉粥样硬化同LP（a）和TNF‐α相关性，用ROC曲线下面积确定相对参考值。结果实验组TC、TG、LDL‐C水平随着喂养时间的延长明显增高，显著高于基础水平（P＜0．05），高脂喂养2周时HDL‐C较基础水平明显降低（P＜0．05）；PTA术后2月时TNF‐α含量急剧升高，明显高于试验前（P＜0．01）。Logistic回归分析显示术后2月TNF‐α水平对于腹主动脉狭窄发生的危险性比值（RR）为1．84（P＜0．01）。TNF‐α的ROC曲线下面积为0．871（95％CI：0．811～0．956），Lp（α）为0．523（95％CI：0．409～0．720）。结论血脂紊乱是致动脉硬化的重要因素，TNF‐α在PTA后中晚期升高提示其参与了动脉硬化的血管修复过程。
목적：탐토혈관동맥죽양경화급혈관성형술（PTA）후혈관조직결구적개변이급혈지、지단백（a）[LP（a）]화종류배사인자‐α（TNF‐α）재저일과정변화적의의。방법채용30지고지위양신서란토위실험조，10지보통사료위양적순충신서란토작위대조조。분별우실험전、위양2주화PTA술후1、2、3월행혈액생화검사，상규생화법검측총담고순（TC）、삼선감유（TG）、고밀도지단백（HDL‐C）농도，저밀도지단백（LDL‐C）농도，병분비취토주동맥혈관작조직병이학검사。사용다원Logistic회귀분석동맥죽양경화동LP（a）화TNF‐α상관성，용ROC곡선하면적학정상대삼고치。결과실험조TC、TG、LDL‐C수평수착위양시간적연장명현증고，현저고우기출수평（P＜0．05），고지위양2주시HDL‐C교기출수평명현강저（P＜0．05）；PTA술후2월시TNF‐α함량급극승고，명현고우시험전（P＜0．01）。Logistic회귀분석현시술후2월TNF‐α수평대우복주동맥협착발생적위험성비치（RR）위1．84（P＜0．01）。TNF‐α적ROC곡선하면적위0．871（95％CI：0．811～0．956），Lp（α）위0．523（95％CI：0．409～0．720）。결론혈지문란시치동맥경화적중요인소，TNF‐α재PTA후중만기승고제시기삼여료동맥경화적혈관수복과정。
Objective To investigate the changes of atherosclerosis and vascular tissue after pecutaneous tranluminal angioplasty (PTA) ,and evaluate the role of serum lipid ,lipoprotein (a) [Lp(a)] and tumor necrosis factor‐α(TNF‐α) in this progress .Methods Thirty New Zealand white rabbits with high fate diets were established as observation group ,and 10 rabbits with normal feed were set as control group .Blood biochemistry test was used to detect the levels of serum TC ,TG ,HDL‐C ,LDL‐C ,Lp(a) and TNF‐αbefore the experiment ,after 2 weeks feeding and 1 month ,2 months ,3months after PTA .The correlation among atherosclerosis and Lp(a) ,TNF‐a were measured by multiple logistic regression analysis .Opposite reference value was calculated with receiving operating characteristics (ROC) analysis .Results The levels of TC ,TG and LDL‐C were significant higher than baseline with the feeding time(P<0 .05) .The level of HDL‐C after 2 weeks high cholesterol diet feeding was lower than baseline (P<0 .05) .The content of TNF‐αat 2nd month after PTA was remarkable higher than baseline(P<0 .01) .ROC analysis showed that RR of TNF‐a was 1 .84(P<0 .01) and an area under the curve of 0 .871 for TNF‐α (95% CI:0 .811 -0 .956) compared to 0 .523 for Lp(a) (95% CI:0 .409-0 .720)regarding atherosclerosis .Conclusion The turbulence of lipid could be an important factor of atherosclero‐sis ,and the high level of TNF‐αmay take part in the process of repairing of arteriosclerotic vessel .