Long-term effects of surgical angiogenic therapy with fibroblast growth factor 2 protein
Long-term effects of surgical angiogenic therapy with fibroblast growth factor 2 protein
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DOI：
10.1067/mtc.2002.121974
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发表时间：
2002-07-01
影响因子：
6
通讯作者：
Sellke, FW
中科院分区：
文献类型：
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作者：
Ruel, M;Laham, RJ;Sellke, FW
目的：探讨手术治疗成纤维细胞生长因子2的远期疗效。方法：在一项随机双盲研究中，在接受冠状动脉旁路移植术的患者的不可移植心肌区域给予成纤维细胞生长因子2（10杯或100杯）或安慰剂（各8杯），随访至术后32.2+/-6.8个月，进行临床评估和核灌注成像。有2例晚期死亡，1例死于胰腺癌，1例死于原因不明（均在100杯成纤维细胞生长因子2组）。2例患者（均为对照组）因复发性冠状动脉事件共接受6次重复心导管插入术。加拿大心血管学会（Canadian Cardiovascular Society）的心绞痛等级在随访后期均较基线有所改善（P <或等于0.02）；然而。接受两种剂量成纤维细胞生长因子2治疗的患者比接受安慰剂治疗的患者心绞痛复发的自由程度显著提高（P = .03）。晚期核灌注扫描显示，5名接受安慰剂治疗的患者中有4名在不可移植区域存在持续可逆或新的固定灌注缺陷，而9名接受成纤维细胞生长因子2治疗的患者中只有1名（P = 0.02）。成纤维细胞生长因子2治疗组患者左心室应激灌注缺损评分的总和也低于对照组（分别为1.3+/-1.4 vs 3.9+/-2.1: P = 0.04）。纤维母细胞生长因子2治疗组患者晚期左心室射血分数呈较高趋势（55.1%+/-14.6% vs 44.3%+/-6.5%，纤维母细胞生长因子2治疗组与对照组：P = 0.12）。结论：这些数据表明，手术血管生成治疗与缓释成纤维细胞生长因子2可能导致延长心肌血运重建的效果，可以转化为临床获益。
Objective: The long-term effects of surgical fibroblast growth factor 2 therapy are examined.Methods: In a randomized, double-blind study, fibroblast growth factor 2 (10 mug or 100 mug) or placebo (n = 8 each) was delivered in the ungraftable myocardial territory of patients concomitantly undergoing coronary artery bypass grafting Patients were followed up to 32.2+/-6.8 months postoperatively with clinical assessment and nuclear perfusion imagingResults: Baseline patient characteristics were similar between the 3 groups. There were 2 late deaths, one of pancreatic cancer and one of undetermined cause (both in the 100-mug fibroblast growth factor 2 group). Two patients (both in the control group) underwent a total of 6 repeat cardiac catheterizations for recurrent coronary events. Mean Canadian Cardiovascular Society angina class improved at late follow-up from baseline in all groups (P less than or equal to .02); however. patients treated with either dose of fibroblast growth factor 2 had significantly more freedom from angina recurrence than those treated with placebo (P = .03). Late nuclear perfusion scans revealed a persistent reversible or a new, fixed perfusion defect in the ungraftable territory of 4 of 5 patients who received placebo versus only I of 9 patients treated with fibroblast growth factor 2 (P = .02). The overall sum of left ventricular stress perfusion defect scores was also lower in fibroblast growth factor 2-treated patients than in control subjects (1.3+/-1.4 vs 3.9+/-2.1, respectively: P = .04). A trend toward a higher late left ventricular ejection fraction was noted in fibroblast growth factor 2-treated patients (55.1%+/-14.6% vs 44.3%+/-6.5%, fibroblast growth factor 2-treated patients versus control subjects: P = .12).Conclusions: These data suggest that surgical angiogenic therapy with sustained-release fibroblast growth factor 2 may result in a prolonged myocardial revascularization effect that could translate into clinical benefit.