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目的:探讨32P液体球囊血管内照射预防血管成形术后再狭窄的量效关系,及其抑制再狭窄发生的可能机制。方法:取24只大耳白兔,建立兔双侧髂动脉粥样硬化狭窄模型,随机选择一侧髂动脉血管成形术并分别给予9.1Gy、21.8Gy和33.4Gy32P液体球囊血管照射治疗,另一侧作为自身对照。术后5周行血管造影并取材进行光镜、电镜观察,增殖细胞核抗原(PCNA)、抑癌基因P53免疫组织化学染色,用计算机图像分析其组织形态学改变。结果:9.1Gy组未观察到明显的生物效应;21.8Gy组血管壁平滑肌细胞增殖和迁移明显受抑,管腔面积无明显丢失;33.4Gy组管腔重度狭窄,内膜严重增厚,中膜平滑肌明显萎缩变薄,4例血管腔内血栓形成。结论:32P液体球囊在一定的吸收剂量范围内确可安全有效地防止血管成形术后再狭窄形成,其机制可能为抑制新生内膜形成和管腔面积丢失;促进平滑肌细胞凋亡以及抑制血管负性重塑。
Objective: To investigate the dose-response relationship of 32P liquid balloon intravascular irradiation to prevent restenosis after angioplasty and its possible mechanism of inhibiting restenosis. Methods: Twenty-four large white rabbits were used to establish bilateral iliac artery atherosclerosis model of rabbits. One side of iliac artery angioplasty was randomly selected and treated with 9.1Gy, 21.8 Gy and 33.4 Gy32P liquid balloon angioplasty respectively. One side as self-control. At 5 weeks after operation, angiography was performed and the specimens were taken for light microscopy, electron microscope observation, PCNA and tumor suppressor gene P53 immunohistochemical staining. The morphological changes were analyzed by computer image. Results: The obvious biological effects were not observed in 9.1Gy group. The proliferation and migration of vascular smooth muscle cells in 21.8Gy group were significantly inhibited and the luminal area was not significantly lost. The severe stenosis of lumen in 33.4Gy group, severe intimal thickening, Smooth muscle atrophy and thinning, 4 cases of intravascular thrombosis. Conclusion: The 32P liquid balloon can prevent the restenosis after angioplasty safely and effectively in a certain range of absorbed dose. Its mechanism may be to inhibit neointima formation and luminal area loss, promote the apoptosis of smooth muscle cells and inhibit blood vessel Negative remodeling.