The Changes Of Serum VEGF Levels Before And After PCI On The Patients With Single-vessel Disease

Objective:Coronary heart disease (CHD)is one of the principal diseases that harmshuman health in today’s world.The incidence and mortality increased year byyear and it has become the top killer of human health.The main pathologicalbasis of myocardial ischemia and necrosis is coronary atherosclerosis plaqueformation caused stenosis or occlusion. A large number of study found thatstability plaques maybe don’t produce any symptoms or only angina pectorisby fatigue induced,but vulnerable plaque can cause plaque rupture andthrombosis, thus leading to the occurrence of acute cardiovascular events.Atpresent,Both at home and abroad unanimously coronary heart disease divideinto acute coronary syndrome and chronic coronary disease.According to theelectrocardiogram and Serum myocardial necrosis mark, ACS is divided intoAcute ST-elevation myocardial infarction, non ST-elevation myocardialinfarction and unstable angina.Chronic coronary disease is divided into stableangina, coronary normal angina pectoris (X syndrome), asymptomaticmyocardial ischemia and ischemic cardiomyopathy.For Acute myocardialinfarction、Unstable angina and stable angina,we often implement PCI therapyClinically. The common features of this kind of disease are myocardial bloodsupply and the myocardial cell population declined rapidly. The key fortreatment is as soon as possible to open the criminal blood vessels,quicklyrecover blood-supply of ischemic area and infarction area.At home and abroad,the methods of revascularization are mainly PCI, CABG and two hybridsurgery,which all can remove coronary artery stenosis quickly and recovermyocardial perfusion, which are effective means to cure CHD. However,whether PCI or CABG only restores blood flow to the big vessels, there has noobvious amelioration to myocardial diffusion and small vascular lesions. In recent years the domestic and international research report that VEGFcan improve small vascular lesions blood flow of myocardial. VEGF is a kindof promoting angiogenesis factor.Some factors can stimulate endothelial cells,smooth muscle cells and macrophages to secrete VEGF, for exampleinflammatory factor, low PH and tumor cells, mainly ischemia andanaerobic.The VEGF level increases significantly, and promotes angiogenesisand collateral circulation formation, when the body is ischemia and anaerobic.In a certain degree, it can improve myocardial ischemia, reduce themyocardial cell apoptosis and enhance myocardial contraction ability, in acertain extent, improve cardiac function in patients with coronary heartdisease.Through testing serum VEGF level of CHD patients after and before PCI,compared, analyzed and discussed the serum VEGF level changes.Materials and methods:52CHD patients served as the experimental group, male30cases, female22cases, age30-78years, average63.45±9.36,who had been confirmed to besingle-vessel disease (involved the left anterior descending coronary artery,right coronary artery or left circumflex artery, and the inner diameter stenosisis greater than75%) by coronary angiography. We detected the serum VEGFlevels respectively before PCI,40minutes and7day after the PCI. Meanwhile,50normal subjects served as the control group, male20cases, female30cases,age25-78years, average61.26±8.26.We detected the serum VEGF levelsrespectively before PCI,40minutes and7day after the PCI. The age, gender,smoking, high blood pressure, high cholesterol and diabetes between twogroups had no statistical significance. Then we analyze and compare the serumVEGF level change.Results:The VEGF levels were significantly higher in the study group than in thecontrol group. The VEGF levels in the experimental group increasedsignificantly40minutes after PCI while decreased obviously7days after PCIcompared with those before PCI.The normal subjects have no obvious change. Conclusion:1. The contradiction of myocardial blood-oxygen supply and demandexist in CHD patients, ischemia and anaerobic is one of the main factors tostimulate VEGF rise,then the serum VEGF level in CHD patients obviouslyhigher than that of normal control group,which can promote collateralcirculation formation, in a certain degree,which can improve myocardialischemia. The factors affecting serum VEGF levels were eliminated as far aspossible under the existing experimental condition and test conditions in thisexperiment(tumor, inflammation, liver and kidney and blood system diseasesand infectious diseases, etc), the rise of VEGF levels can prompt coronaryischemia-anaerobicstimulate endothelial cells to secrete VEGF.2. Balloon expansion and stent placement damage vascular endothelial inPCI, which lead to local inflammatory reaction and thrombosis. Endothelialprogenitor cells proliferate and migrate to locality, and differentiate for matureendothelial cells, then secrete VEGF. VEGF can effect on vascular endothelialcells by positive feedback, and a large number of VEGF can be released, thenserum VEGF level increased significantly after PCI.A high level of VEGF canpromote re-endothelialization process, recover endothelial cell barrier functionas soon as possible, and prevent local thrombosis.To a certain extent, vascularsmooth muscle cell can be restrained to proliferate excessive, and this canagainst superoxide injury produced in PCI process, restrain vascularendothelial excessive hyperplasia, which thrombosis and restenosis can bedecreased after PCI.3. Myocardial ischemia and anaerobic can be improved effectivelybecause of vascular remodeling and blood flow restoration after PCI.At thesame time, endothelial injury and inflammation can recover in a certaindegree.after seven days, the serum VEGF levels dropped to the level below thepreoperative level, but that is still higher than that of normal control group ofpreoperative level.The results show that the level of serum VEGF can reactsensitively and early coronary inflammation, endothelial repaired andreascularization situation after PCI. To a certain extent, it can become an important index to react coronary ischemia-anaerobic, which has a certainreference value for the diagnosis of CHD. Serum VEGF level increasedsignificantly after PCI in single lesion patients and a high level of serumVEGF has certain benefits to prevent restenosis after PCI. Animal experimentsalso confirmed that VEGF can prevent restenosis after angioplasty. Becausethis experiment sample number is limited, it is necessary to enlarge the samplenumber and to do a large number of clinical trials, then to evaluate myocardialischemia and judge treatment effect and prognosis.