抗血小板药物对兔髂股动脉球囊损伤后管腔狭窄的影响
항혈소판약물대토가고동맥구낭손상후관강협착적영향
Effect of antiplatelet therapy on vascular stenosis in the balloon injured iliac-femoral artery of rabbit
  • 万方数据
    国际外科学杂志 국제외과학잡지
    International Journal of Surgery
    2015年 9期 600-604,封3 ,共6页

    马天翔%张福先%成龙%李海磊

    마천상%장복선%성룡%리해뢰

    股动脉%内皮细胞%球囊扩张%阿司匹林%西洛他唑%氯吡格雷 股動脈%內皮細胞%毬囊擴張%阿司匹林%西洛他唑%氯吡格雷
    고동맥%내피세포%구낭확장%아사필림%서락타서%록필격뢰
    Femoral artery%Endothelial cells%Balloon Dilation%Aspirin%Cilostazol%Clopidogrel
    目的 评价不同抗血小板药物及其联合应用方案,对兔髂股动脉球囊损伤后内皮细胞修复作用及对管腔狭窄的影响.方法 将56只雄性新西兰兔通过完全随机方式分为假手术组、模型组以及用药组,用药组包括阿司匹林组、两洛他唑组、氯吡格雷组、阿司匹林+西洛他唑组、阿司匹林+氯吡格雷组,共7组,每组8只.使用球囊损伤右侧髂股动脉后制作髂股动脉球囊损伤狭窄模型,术后第14天处死实验兔,取出血管标本,经处理后,测量动脉管腔面积,内弹力层、外弹力层围绕面积,计算内膜、中膜面积和内膜/中膜面积比值.结果 (1)假手术组兔右侧髂股动脉内皮细胞未见增生,模型组与各用药组均可见内皮细胞增生;与模型组相比,各用药组增生均有明显减轻[(阿司匹林组vs西洛他唑组vs氯吡格雷组vs模型组:新生内膜面积:(0.32±0.11) mm2 vs (0.20±0.03) mm2vs (0.30±0.10) mm2vs(0.52±0.20) mm2,P＜0.05;内膜/中膜面积比值:(0.76±0.02)vs(0.90±0.06)vs(0.83±0.11)vs(1.78±0.05),P＜0.05];(2)单独应用两洛他唑对于抑制球囊损伤后内膜增生的效果明显优于阿司匹林及氯吡格雷[阿司匹林组vs西洛他唑组vs氯吡格雷组:新生内膜面积:(0.32±0.1 1) mm2vs(0.20±0.03) mm2 vs (0.30±0.10) mm2,P＜0.05];氯吡格雷+阿司匹林组与西洛他唑+阿司匹林组在抑制血管损伤后内膜增生的作用上效果均明显优于阿司匹林组[阿司匹林组vs两洛他唑+阿司匹林组vs氯吡格雷+阿司匹林组:新生内膜面积:(0.32 ±0.11) mm2 vs (0.18 ±0.06) mm2vs (0.19±0.07) mm2,P＜0.05];氯吡格雷+阿司匹林组与西洛他唑+阿司匹林组的联合用药的效果差异无统计学意义[西洛他唑+阿司匹林组vs氯吡格雷+阿司匹林组:新生内膜面积:(0.18 ±0.06) mm2vs(0.19±0.07)mm2,P＞ 0.05].结论 (1)不同的抗血小板药物及联合应用可以抑制球囊损伤后兔髂股动脉内膜损伤后再狭窄;(2)西洛他唑对于预防内膜损伤后再增生较阿司匹林、氯吡格雷有一定优势;(3)西洛他唑及西洛他唑与其他抗血小板药物联合应用在预防经皮腔内血管成形术术后再狭窄方面有一定的潜在临床应用价值.
    목적 평개불동항혈소판약물급기연합응용방안,대토가고동맥구낭손상후내피세포수복작용급대관강협착적영향.방법 장56지웅성신서란토통과완전수궤방식분위가수술조、모형조이급용약조,용약조포괄아사필림조、량락타서조、록필격뢰조、아사필림+서락타서조、아사필림+록필격뢰조,공7조,매조8지.사용구낭손상우측가고동맥후제작가고동맥구낭손상협착모형,술후제14천처사실험토,취출혈관표본,경처리후,측량동맥관강면적,내탄력층、외탄력층위요면적,계산내막、중막면적화내막/중막면적비치.결과 (1)가수술조토우측가고동맥내피세포미견증생,모형조여각용약조균가견내피세포증생;여모형조상비,각용약조증생균유명현감경[(아사필림조vs서락타서조vs록필격뢰조vs모형조:신생내막면적:(0.32±0.11) mm2 vs (0.20±0.03) mm2vs (0.30±0.10) mm2vs(0.52±0.20) mm2,P＜0.05;내막/중막면적비치:(0.76±0.02)vs(0.90±0.06)vs(0.83±0.11)vs(1.78±0.05),P＜0.05];(2)단독응용량락타서대우억제구낭손상후내막증생적효과명현우우아사필림급록필격뢰[아사필림조vs서락타서조vs록필격뢰조:신생내막면적:(0.32±0.1 1) mm2vs(0.20±0.03) mm2 vs (0.30±0.10) mm2,P＜0.05];록필격뢰+아사필림조여서락타서+아사필림조재억제혈관손상후내막증생적작용상효과균명현우우아사필림조[아사필림조vs량락타서+아사필림조vs록필격뢰+아사필림조:신생내막면적:(0.32 ±0.11) mm2 vs (0.18 ±0.06) mm2vs (0.19±0.07) mm2,P＜0.05];록필격뢰+아사필림조여서락타서+아사필림조적연합용약적효과차이무통계학의의[서락타서+아사필림조vs록필격뢰+아사필림조:신생내막면적:(0.18 ±0.06) mm2vs(0.19±0.07)mm2,P＞ 0.05].결론 (1)불동적항혈소판약물급연합응용가이억제구낭손상후토가고동맥내막손상후재협착;(2)서락타서대우예방내막손상후재증생교아사필림、록필격뢰유일정우세;(3)서락타서급서락타서여기타항혈소판약물연합응용재예방경피강내혈관성형술술후재협착방면유일정적잠재림상응용개치.
    Objective The purpose of the experiment is to research the effects of different kind of anti-platelet drugs and their combinations in prevention of vascular restenosis after ballon-injury, and to evaluate the best way of clinical utility of anti-platelet drugs.Methods Fifty-six male New Zealand White Rabbits were randomly assigned to 3 groups: the control group (ML) , the model group (M) , the experimental group.The experimental group was divided to 5 subgroups, the aspirin group (A), the cilostazol group (B) , the clopidogrel group (C), the aspirin plus cilostazol group (A + B) , and the aspirin plus colopidogrel group (A + C).Femoral artery stenosis model was induced by halloon injury except the control group.The rabbits were fed different drugs 3 days before operation except the normal group and the model group.On the 14th day after operation, the rabbits were sacrificed and the iliofemoral arteries were removed and made to the pathological section.We measured the internal elastic lamina, external elastic lamiua and luminal areas measured.Then calculate the area of intima, media and the ratio of intima vs.media.Results ①There is no endothelium hyperplasia in control group.Compared with the control group, we observed endothelium hyperplasia in both model group and the experimental groups.Compared with the model group, endothelium hyperplasia in all experimental groups is in a lower degree;② Cilostazol alone works better than aspirin alone and clopidogrel alone in prevention of vascular restenosis after ballon-injury.Clopidogrel combined with aspirin and cilostazol combined with aspirin both work better than aspirin alone in prevention of vascular restenosis after ballon-injury.There is no apparent difference between the effect of clopidogrel combined with aspirin and cilostazol combined with aspirin.Conclusions ① Different anti-platelet drugs and different combinations of them can prevent the happening of vascular restenosis after ballon-injury.② Cilostazol works better than aspirin and clopidogrel in prevention the happening of vascular restenosis after ballon-injury, and combination of anti-platelet drugs which contains cilostazol works better than other way of combination of anti-platelet drugs.③ Cilostazol and combination of anti-platelet drugs which contains cilostazol is potential useful in clinical uses to prevent restenosis after PTA.
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