| Background and PurposesHistologic and pathologic findings have suggested that coronary artery restenosis after intracoronary stent implantation (ISI) is characterized by proliferation and migration to tunica intima of vascular smooth muscular cells (VSMC). Cellular hyperproliferation and deficient apoptosis may be the mechanism of coronary artery restenosis after intracoronary stent implantation. The studies performed in animal models have confirmed that migration and proliferation of smooth muscular cells are the key factors. Local tissue smooth muscular cells proliferate markedly after ISI. The activity of proliferation is maximal within 1 week and disappears at 4 weeks after ISI. The apoptosis of VSMC is regulated by many genes, including C-myc, P53, Bcl-2, and Fas et al. Bcl-2, that is B-cell lymphoma/leukemia-2 gene is oncogene. The products of Bcl-2 gene can suppress apoptosis. Hyperexpression of Bcl-2 gene may facilitate VSMC mitosis andproliferation, as well as hypersecretion of extracelluar matrix thus contributing to restenosis. RAVEL trial reveals that the restenosis rate and one-year non-event survival are 0% and 94% respectively by the usage of rapamycin-eluting stents within half a year follow-up after ISI.The study of whether the sustained hyperexpression of serum Bcl-2 is occurred after percutaneous transluminal coronary angioplasty (PTCA) and ISI is not yet reported at home. In our study, dynamic change of serum Bcl-2 concentration before and after ISI was observed. The effects of routinely medicine therapy, such as statins, clopidogrel, aspirin, nitroglycerin, on the serum concentration of Bcl-2 were investigated. The impacts of rapamycin-eluting stents versus bare stents were also studied. Sample as rapamycin-eluting stents ,the impacts on the serum concentration of Bcl-2 were investigated of PTCA+stent implantation versus direct stent implantation were also studied.MethodsDuring September 2004 to february 2005,in the First Affiliated Hospita of Zhejian University or the people's hospital of Yuyao city,66 consecutive coronary heart disease patients who underwent coronary arteriography(CAG) were enrolled in this study,and patients with history of diseases in liver or kidney, concomitant malignant, immunity system diseases, diabetes, thyroid gland disease,hypertension uncontrolled and other seriousdisease were excluded. 18 normal healthy person without any drug as normal control.All patients have the routinely medicine therapy in 4~14 days before CAG, such as statins, clopidogrel, aspirin, ACEI or ARB, nitroglycerin. Performed CAG we found 48 patients have coronary atherosclerosis(the positive group).There were 18 patients without ISI. In the 30 patients underwent ISI, 18 rapamycin-eluting stents versus 12 bare stents. 18 patients had normal CAG results in the negative group. The levels of serum Bcl-2 are detected by ELISA in all patients and the negative groupand normal healthy pearsons(the control group) before CAG , 7~10 days and 30~40 days after ISI. The incidence and seventh of coronary atherosclerosis were evaluated by CAG and the Gensini's scores. The way of PTCT+Stent was standard.Statistical Analysis: Comparison of groups were performed by the t-test for independent samples and analysis of variance using SPSS 11.0.We also used One-Way ANOVA(LSD), a multiple logistic-regression model combining clinical finding.A P value <0.05 was considered statistically significant.Results:1.The clinical materials of every groups had no significantly different respectively.2.The levels of serum Bcl-2 between the positive group and the negative group were not significantly different respectively before CAG (P>0.05) . The levels of serum Bcl-2 of the normal control group was significantly much superior to that of either the positive group or the negative group respectively before CAG (P<0.05) .3. The levels of serum Bcl-2 of ISI group either 7~10 days or 30~40 days after ISI were superior to that of before CAG respectively. (P <0.05). The levels of serum Bcl-2 of ISI group at the 7~ 10 days after ISI we... |
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