【作者】 范磊；

【导师】 张金盈；

【作者基本信息】 郑州大学 ， 心血管内科学， 2012， 硕士

【摘要】 背景Tambe等于1972年最先报道了冠状动脉慢血流(coronary slow flow, CSF)这一现象,此后随着冠状动脉造影技术的普及CSF逐渐被心脏介入医生所熟悉。统计显示,所有接受冠状动脉造影的患者中CSF的发生率约为1%,而在因怀疑心血管疾病接受冠状动脉造影的患者中CSF现象的发生率达到了7%。CSF可引起心肌缺血,临床上患者可出现胸闷、胸痛等典型心绞痛症状,有大约20%的病人需要反复住院治疗,严重时可发生恶性心律失常及心源性猝死,但其发病机制目前尚不明确。国内外一些研究提示CSF患者存在内皮功能障碍,内皮功能障碍可能是CSF发生的一种病理机制。内皮祖细胞(endothelial progenitor cells, EPCs)作为血管内皮细胞的前体,可增殖并修复损伤的内皮细胞,内皮细胞受损时,EPCs释放入外周血,分化、增殖、迁移并整合至内皮损伤部位,参与内皮修复过程,而致EPCs自身数量的减少,因此人外周血EPCs的数量可在一定程度上反映各种因素对内皮细胞的损害程度。基于以上研究,本实验对CSF患者外周血EPCs数量进行测定,来探讨CSF的发病机制。目的观察冠状动脉慢血流患者外周血内皮祖细胞(EPCs)数量的变化。方法选择26例冠状动脉造影证实为慢血流患者为CSF组,冠脉造影血流正常患者20例为NCF (normal coronary flow)组。以校正TIMI帧数(corrected TIMI frame count, CTFC)>27诊断为冠状动脉慢血流。分别对两组患者抽取外周静脉血进行EPCs的分离培养,于第10天对EPCs进行鉴定,并于倒置像差显微镜下计数内皮祖细胞克隆形成单位(EPC-CFU),评估两组患者外周血EPCs水平的差异。结果①两组在年龄、性别、吸烟史、高血压、糖尿病、冠心病家族史、血脂方面均无明显统计学差异(P>0.05)；②CSF组外周血EPCs水平较NCF组明显下降(11.3±2.9vs.17.1±2.4),差异有统计学意义(P<0.05)。结论冠状动脉慢血流患者外周血EPCs数量减少。更多还原

【Abstract】 BackgroundCoronary slow flow (CSF) phenomenon was first proposed by Tambe in1972, then it was gradually well known to interventional cardiologists with the popularity of coronary angiography. It was reported that, about1%population have CSF phenomenon in patients underwent coronary angiography, another reserch reported that coronary angiography found about7%population have CSF phenomenon in the patients with suspected cardiovascular disease. CSF phenomenon can cause myocardial ischemia, the patients can have exertional angina pectoris or acute coronary syndrome (ACS), about20%of the patients need repeated hospitalization, it can happen malignant arrhythmia and sudden cardiac death when serious, but its pathogenesis is still not clear. Some foreign studies suggested that the patients with CSF had endothelial dysfunction. Endothelial dysfunction may be a pathological mechanism of CSF. Endothelial progenitor cells (EPCs) are precursores of the vascular endothelial cells, they can propagate and repair the damaged endothelial cells, when the endothelial cells are damaged, EPCs are released into the peripheral blood, proliferate and differentiate, migrate and integrate to the endothelial injuried parts, participate in endothelial repair process, which is due to the reduction of the number of EPCs itself, so the number of EPCs peripheral blood in a certain extent reflects various factors on endothelial cell damage. Based on the study above, we want to investigate the pathogenesis of CSF through counting the number of circulating EPCs in patients with CSF.ObjectiveTo investigate the changes of circulating endothelial progenitor cells(EPCs) from peripheral blood in patients with coronary slow flow(CSF).MethodsTwenty six CSF patients (CSF group) and20normal CAG patients served as control group(NCF group) were selected in this study. CSF was diagnosed when the corrected TIMI frame count(CTFC) was more than27frames. Peripheral blood samples were drawn to isolate and culture EPCs,respectively. EPCs populations were assessed using the colony forming unit assay(EPC-CFU) through an inverted phase contrast microscope after10days culture.ResultsThere were no significant differences in age, sex, smoking history, hypertension,diabetes mellitus, family histoy of coronary heart disease and lipid profile between2groups(P>0.05);the level of circulating EPCs in CSF group was lower than that in NCF group(11.3±2.9vs.17.1±2.4,P<0.05).ConclusionCircualting EPCs populations are lower in CSF patients.更多还原