Expression Of P-selectin, Endothelin-1in Patients With Peripheral Arterial Disease After PTA And Endovascular Stent

Peripheral arterial disease（PAD）is common diseases of vascular surgery, the incidencerate increased with age. Especially increase of>50years of age, diabetes mellitus,hypertension and smoking in the population, the incidence rate can be as high as29%.Drug treatment for severe stenosis or occlusion usually got poor efficary. Majority ofpatients with PAD is more complex, often involving multipanar, multi-segment changesand heart, lung, brain dysfunction, they can not tolerate a greater surgical trauma.Percutaneous transluminal angioplasty （PTA） and stenting make the treatment of PADbecoming minimally anvasive, safe, effective. In recent years, PTA and stenting hasbecome an important method of clinical treatment of PAD. However, arterial restenosisafter endovascular treatment is one of the difficult and hot issue that clinicians face on,mainly dueing to intimal hyperplasia triggered by damage of the vascular endothelialinjury caused by endovascular treatment. P-seletin and endothelin-1are importantadhesion factor and vascular contraction factor secreted by vascular endothelial cells.They play an important role in the process of intimal hyperplasia after vascularendothelial injury. The purpose of this study is to explore the expression andsignificance of plasma P-selectin and endothelin-1in patients with PAD after PTA andendovascular stentMaterials and methods:Choose20patients（24bodies） with PAD during September2010to September2011who had been treated in the first affiliated hospital of An Hui medical university, the clinical manifestations according to Rutherford’s stage: Ⅲ of severe intermittentclaudication,3cases; Ⅳ of rest pain,9cases; Ⅴ of smaller tissue defects,4cases; Ⅵofulcers and gangrene,4cases; preoperative ankle-branchial index（ABI） was0.32±0.15.All patients were accurate diagnosised by CTA.4ml blood was collected from branch’svein of patients with PAD before PTA and endovascular stent and1hour,6hours,24hours,2weeks after stenting.2ml of4ml blood was put into the tube with10%EDTANa₂30ml and bestatin40ul, and1.8ml was placed into the tube with2%EDTANa₂0.2ml.under temperature4℃,bood samples were discentered for ten minutesat3000rounds/minutes, and then was stored in temperature-80℃in refrigerator. Theplasma levels of ET-1were measured by radioimmunoassay and the plasma levels of Pswere examined by ELISA. Statistical analysed was analysed with software SPSS13.0using T-test, P value <0.05is considered as statistically significant.Results:1.The plasma levels of Ps in1hour,6hour,24hour,2weeks after PTA andendovascular stent:31.20±3.69,29.52±4.08,26.60±3.10,25.86±2.97, are significantlyhigher than before PTA and endovascular stent, respectively P<0.05, and there aresignificant statistical differences;2. The plasma levels of Ps in1hour,6hour,24hour,2weeks after PTA andendovascular stent:78.70±5.09，81.39±4.22，76.61±3.10，75.81±2.99, are significantlyhigher than before PTA and endovascular stent, respectively P<0.05, and there aresignificant statistical differences;3. The plasma levels of Ps in1hour after PTA and endovascular stent reach the peak,and the plasma levels of ET-1in6hour after PTA and endovascular stent reach thepeak. Conclusions:1.The plasma levels of Ps and ET-1are significally raised after PTA and endovascularstent, it demonstrates that endothelial cells （EC） are injuryed on some extent afterendovascular intervention, the blood platelets are activated in some degree;2. P-selectin is a initial adhesion factor started postoperative, which may play a key rolein restenosis after endovasvular treatment;the release of endothelin-1continued toincrease in6hours after endovasvular treatment3. Monitoring plasma levels of Ps and ET-1after endovasvular treatment may be ofgreat value to stratification of clinical therapy and judgment of prognosis.