论文部分内容阅读
目的冠状动脉微栓塞是急性冠脉综合征和冠心病PCI术后的不良后果,严重影响冠心病的预后。目前对早期发现和诊断冠脉微栓塞尚无较好的临床指标。本文通过检测轻度冠脉微栓塞后不同时间点TNF-α和cTnT的血清学水平,探索早期筛查冠脉微栓塞的血清学标志物。方法 12周龄健康小型猪8只,通过经皮冠脉介入法,于前降支中远端,经微导管注入微栓塞球(总计5万个,直径42μm)建立轻度冠状动脉微栓塞模型,微栓塞术前、术后2小时、6小时、1周分别采集股动脉血,以酶联免疫法(ELISA)法检测各时间点的血清TNF-α水平,以电化学发光法检测血清cTnT水平;术后1周时,处死动物,收集心肌组织标本,行四氮唑蓝染色,检测心肌梗死灶;对前壁、后壁心肌组织切片行HE染色,检测微梗死灶;同时以免疫组化法检测心肌组织中TNF-α的蛋白表达。结果与冠脉微栓塞术前(137.97±28.20pg/ml)相比,血清TNF-α在术后两小时即达到峰值(256.35±68.27pg/ml,P<0.01),术后1周(103.42±16.68pg/ml)降至术前水平,而一周时TNF-α前壁心肌组织表达高于后壁;cTnT在术后6小时才升至峰值水平(0.158±0.161ng/mlvs术前<0.01ng/ml,P<0.05),术后1周(0.041±0.053ng/ml)仍高于术前水平。心肌HE染色示,5万微球的冠脉微栓塞不足以引起心肌微梗死灶的形成。结论相比于血清cTnT,轻度冠状动脉微栓塞后血清TNF-α水平更早达到峰值;cTnT虽然达峰偏晚,但持续时间可达一周左右,二者结合对早期发现和诊断冠脉微栓塞起重要作用。
The purpose of coronary micro-embolism is acute coronary syndrome and coronary artery disease after PCI adverse consequences, seriously affecting the prognosis of coronary heart disease. At present there is no good clinical indication for early detection and diagnosis of coronary micro-embolism. In this paper, serum levels of TNF-α and cTnT at different time points after mild coronary microembolism were detected to explore the early screening of coronary micro-embolization serological markers. Methods Eight healthy 12-week-old miniature piglets were treated with percutaneous coronary intervention (PCI) in the middle and distal anterior descending artery. Micro-embolism balls (50000 in total, 42μm in diameter) The arterial blood was collected at 2, 6 and 1 week after micro-embolization. Serum levels of TNF-α were measured by enzyme-linked immunosorbent assay (ELISA) at different time points. Serum cTnT The animals were sacrificed at 1 week after operation. Myocardial tissue samples were harvested and stained with tetrazolium tetrazolium (MNT) for detection of myocardial infarction. HE staining was performed on the anterior wall and posterior wall of myocardial tissue to detect micro-infarct. At the same time, Method to detect myocardial TNF-α protein expression. Results The level of serum TNF-α peaked at two hours after operation (256.35 ± 68.27pg / ml, P <0.01) compared with that before coronary micro-embolization (137.97 ± 28.20pg / ml) ± 16.68pg / ml) to the preoperative level, while the expression of TNF-α in the anterior myocardial tissue was higher than that in the posterior wall at one week; cTnT peaked at 6 hours after operation (0.158 ± 0.161ng / ml vs preoperative <0.01 ng / ml, P <0.05), and still remained higher than preoperative one week after operation (0.041 ± 0.053ng / ml). HE staining showed that 50000 microspheres of coronary micro-embolism is not enough to cause the formation of myocardial infarction. Conclusions Compared with serum cTnT, serum TNF-αlevel peak earlier than that of mild coronary artery embolization. Although cTnT reaches its peak late, its duration lasts up to one week. The combination of the two can not only detect and diagnose coronary microembolic Embolism plays an important role.