Early remodeling of lower extremity vein grafts: Inflammation influences biomechanical adaptation
Early remodeling of lower extremity vein grafts: Inflammation influences biomechanical adaptation
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DOI：
10.1016/j.jvs.2008.01.009
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发表时间：
2008-06-01
影响因子：
4.3
通讯作者：
Conte, Michael S.
中科院分区：
文献类型：
--
作者：
Owens, Christopher D.;Rybicki, Frank J.;Conte, Michael S.
背景：动脉化后静脉搭桥术后的重塑尚不完全清楚。我们以前已经证明，在植入的第一个月内，会发生显著的外向管腔重构，但这种反应的大小是高度可变的。我们试图验证全身炎症影响这一早期重塑反应的假说。方法：对75例接受自体静脉转流术的患者进行了前瞻性观察研究。结果：移植静脉内径在0~1个月的变化(中位数增加22.7%)与初始切应力呈正相关(P=.016)，但在基线超敏C反应蛋白(HsCRP)水平升高的受试者中，这种剪切依赖性反应被破坏，尽管植入时静脉直径和剪应力相似，但hsCRP升高组的移植物0~1个月的阳性重塑较少(13.5%vs40.9%，P=.0072)。经回归分析，hsCRP的自然对数与0~1个月管腔直径变化呈负相关(P=0.018)。他汀类药物治疗(β=23.1，P=.037)、hsCRP(β=-29.7，P=.006)和初始切应力(β=.85，P=.003)与移植静脉早期重塑独立相关。相比之下，1个月时的室壁厚度在hsCRP风险组之间没有差异。高hsCRP组移植静脉在1个月时趋于僵硬，表现为较高的计算弹性系数(E=50.4比25.1Mdynes/cm(2)，P=0.07)。结论：移植静脉早期的正向重塑是一种受全身炎症调节的剪切依赖性反应。这些数据表明，基础炎症影响静脉移植物的愈合，因此，炎症可能是改善静脉移植物早期适应的相关治疗靶点。
Background: The remodeling of vein bypass grafts after arterialization is incompletely understood. We have previously shown that significant outward lumen remodeling occurs during the first month of implantation, but the magnitude of this response is highly variable. We sought to examine the hypothesis that systemic inflammation influences this early remodeling response.Methods: A prospective observational study was done of 75 patients undergoing lower extremity bypass using autogenous vein. Graft remodeling was assessed using a combination of ultrasound imaging and two-dimensional high-resolution magnetic resonance imaging.Results: The vein graft lumen diameter change from 0 to 1 month (22.7% median increase) was positively correlated with initial shear stress (P=.016), but this shear-dependent response was disrupted in subjects with an elevated baseline high-sensitivity C-reactive protein (hsCRP) level of > 5 mg/L. Despite similar vein diameter and shear stress at implantation, grafts in the elevated hsCRP group demonstrated less positive remodeling from 0 to 1 month (13.5% vs 40.9%, P =.0072). By regression analysis, the natural logarithm of hsCRP was inversely correlated with 0- to 1-month lumen diameter change (P =.018). Statin therapy (beta = 23.1, P =.037), hsCRP (beta = -29.7, P =.006), and initial shear stress (beta=.85, P=.003) were independently correlated with early vein graft remodeling. In contrast, wall thickness at 1 month was not different between hsCRP risk groups. Grafts in the high hsCRP group tended to be stiffer at 1 month, as reflected by a higher calculated elastic modulus (E = 50.4 vs 25.1 Mdynes/cm(2), P=.07).Conclusions: Early positive remodeling of vein grafts is a shear-dependent response that is modulated by systemic inflammation. These data suggest that baseline inflammation influences vein graft healing, and therefore, inflammation may be a relevant therapeutic target to improve early vein graft adaptation.