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通过对比有无侧枝循环的冠心病患者冠脉内缺血(CAI)前后白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平的变化,并与反映冠脉缺血强度的量化指标-缺血积分之间进行相关性分析,探讨CAI后早期炎性反应与术后再狭窄的机制,以及侧支循环的作用与意义.73例冠心病患者(Ⅰ),分为CAI组(IA)47例,单纯造影组(IB)26例,CAI组再分为有侧支循环组(IAa)16例,无侧支循环组(IAb)31例.参照Leaman冠脉积分系统,对CAI球囊阻断引起的冠脉缺血强度进行量化;检测正常对照组(Ⅱ)与冠心病组CAI手术前后的IL-6、TNF-α水平变化,并进行相关性分析.冠脉缺血性刺激前IL-6和TNF-α分别为9.601±1.789 pg.mL-1和27.014±1.970 pg.mL-1,在缺血刺激后4 h分别为26.998±1.890 pg.mL-1和79.052±1.555 pg.mL-1,呈显著性差异;有侧支循环组人均总缺血积分与人均最大缺血积分(分别为156.80±24.01与788.70±11.99),显著低于无侧支循环组(分别为341.78±30.58与1111.00±25.31).IL-6、TNF-α是反映冠脉缺血后早期炎性反应的敏感指标,缺血积分可作为反映CAI术中缺血/再灌注损伤程度的的量化指标,侧支循环可减轻冠脉缺血后早期炎症反应,对冠脉缺血有重要代偿与保护作用。
By comparing the changes of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in coronary heart disease patients with or without coronary collaterals before and after coronary ischemia, The correlation analysis between the quantitative indicators of blood-ischemia score and the early inflammatory reaction after CAI and the mechanism of post-operative restenosis, as well as the role and significance of collateral circulation .73 patients with coronary heart disease (Ⅰ) There were 47 cases of CAI group and 26 cases of simple contrast group.The CAI group was further divided into 16 cases with collateral circulation group (IAa) and 31 cases without collateral circulation group (IAb) System to quantify coronary ischemia caused by CAI balloon occlusion and to detect the changes of IL-6 and TNF-α levels before and after CAI in normal control group (Ⅱ) and coronary heart disease group The levels of IL-6 and TNF-α before pulse ischemia were 9.601 ± 1.789 pg.mL-1 and 27.014 ± 1.970 pg.mL-1, respectively, and were 26.998 ± 1.890 pg.mL-1 And 79.052 ± 1.555 pg.mL-1, respectively. There was a significant difference between the total ischemic score and the maximum ischemic score per capita in collateral circulation group (156.80 ± 24.01 and 788.70 ± 11.99, respectively), which were significantly lower than those without collateral circulation Group (minutes Were 341.78 ± 30.58 and 1111.00 ± 25.31, respectively) .IL-6 and TNF-α were the sensitive indexes reflecting the early inflammatory reaction after coronary ischemia, and the score of ischemia could be used as the index to reflect the degree of ischemia / reperfusion injury during CAI Quantitative indicators, collateral circulation can reduce the early post-ischemic inflammation, coronary ischemia has an important compensatory and protective effect.