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目的:探讨不稳定型心绞痛患者血清中是否存在抗血管紧张素Ⅱ1型受体自身抗体及其与冠状动脉(冠脉)支架内再狭窄的关系。方法:随机抽选95例不稳定型心绞痛患者和98例健康受试者,检测外周血清中的抗血管紧张素Ⅱ1型受体自身抗体、细胞因子以及该抗体对血管平滑肌细胞增殖和c-fos、c-jun基因表达的影响。结果:空白对照组、不稳定型心绞痛组及支架植入组的抗体阳性率分别为10.20%、35.79%和47.37%。抗体阳性组及阴性组间细胞因子的变化无统计学意义。体外试验中该自身抗体显示出激动剂样作用,可刺激血管平滑肌细胞增殖,上调c-fos及c-jun基因的表达。这些效应与血管紧张素Ⅱ类似,可部分被AT_1受体拮抗剂缬沙坦阻断。结论:不稳定型心绞痛患者血清中的自身抗体有类似于血管紧张素Ⅱ的效应,可能在冠脉支架术后支架内再狭窄的发病机制中发挥了重要作用。
Objective: To investigate whether there is anti-angiotensin Ⅱ type 1 receptor autoantibodies in the serum of patients with unstable angina and its relationship with coronary in-stent restenosis. Methods: Ninety-five patients with unstable angina pectoris and 98 healthy volunteers were selected randomly to detect anti-angiotensin II type 1 receptor autoantibodies and cytokines in peripheral blood serum and their effects on vascular smooth muscle cell proliferation and c-fos , C-jun gene expression. Results: The antibody positive rates of blank control group, unstable angina pectoris group and stent implantation group were 10.20%, 35.79% and 47.37% respectively. The changes of cytokines between antibody positive group and negative group were not statistically significant. The autoantibodies showed agonist-like effects in vitro and stimulated the proliferation of vascular smooth muscle cells and up-regulated the expression of c-fos and c-jun genes. These effects are similar to those of angiotensin II and are partially blocked by the AT_1 receptor antagonist valsartan. CONCLUSIONS: The serum autoantibodies in patients with unstable angina have a similar effect as angiotensin II and may play an important role in the pathogenesis of in-stent restenosis after coronary stenting.