Endothelial dysfunction of internal thoracic artery graft in patients with chronic kidney disease
Endothelial dysfunction of internal thoracic artery graft in patients with chronic kidney disease
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慢性肾病患者胸内动脉移植物内皮功能障碍
DOI：
10.1016/j.jtcvs.2016.09.037
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发表时间：
2017
影响因子：
6
通讯作者：
Okamura T
中科院分区：
文献类型：
--
作者：
Kinoshita T;Tawa M;Suzuki T;Aimi Y;Asai T;Okamura T
目的本研究旨在评估慢性肾脏疾病与接受冠状动脉搭桥手术患者胸内动脉（ITA）移植血管内皮功能之间的关系。对手术中获得的ITA条进行了等距张力研究。在环加氧酶的抑制下，用苯肾上腺素部分预收缩的ITA条构建乙酰胆碱（ACh）和硝普钠的浓度响应曲线。用硝酸银溶液对管腔表面进行表面染色，组织学上证实内皮细胞的完整性。结果在内皮完好的ITA条中，乙酰胆碱在肾小球滤过率（GFR, mL/min/1.73 m2）为bb60的患者中呈浓度依赖性松弛。在GFR为30 - 60的患者中也观察到浓度依赖性松弛反应，但与GFR为bb60的患者相比，浓度依赖性松弛反应明显减少。在两组中，去除内皮细胞或使用一氧化氮合酶抑制剂几乎可以消除乙酰胆碱所致的松弛。另一方面，在GFR < 30的患者中，高浓度乙酰胆碱诱导的是轻度收缩而不是舒张，这既不能通过NO合成酶抑制剂治疗，也不能通过去除内皮来改变。硝普钠的血管舒张反应在三组间具有可比性。内皮完整条带松弛至ACh浓度峰值与GFR呈正相关。这种关系在多元线性回归模型中成立，GFR与其他危险因素之间的相互作用项没有统计学意义。结论慢性肾病患者ITA移植时内皮细胞释放NO的功能受损。
ObjectivesThe present study was designed to evaluate the association between chronic kidney disease and the endothelial function of internal thoracic artery (ITA) grafts in patients undergoing coronary bypass surgery. An isometric tension study was performed in ITA strips obtained during surgery. Concentration-response curves for acetylcholine (ACh) and sodium nitroprusside were constructed in ITA strips partially precontracted with phenylephrine under the inhibition of cyclooxygenase. The integrity of the endothelium was verified histologically by en-face staining of the luminal surface with the use of silver nitrate solution.ResultsIn endothelium-intact ITA strips, ACh produced a concentration-dependent relaxation in patients with glomerular filtration rate (GFR, mL/min/1.73 m2) > 60. A concentration-dependent relaxation response also was observed in patients with GFR 30 to 60, but it was reduced significantly compared with those with GFR > 60. In both groups, removal of endothelium or treatment with nitric oxide (NO) synthase inhibitors almost abolished the ACh-induced relaxation. On the other hand, in patients with GFR < 30, mild contraction rather than relaxation was induced at a high concentration of ACh, which was modified neither by treatment with NO synthase inhibitors nor by removal of the endothelium. Vasodilator responses to sodium nitroprusside were comparable among the 3 groups. The relaxation of endothelium-intact strips to a peak ACh concentration correlated positively with GFR. This relationship held true in a multiple linear regression model, and interaction terms between GFR and other risk factors were not statistically significant.ConclusionsEndothelial function of ITA grafts to release NO is impaired at the time of surgery in patients with chronic kidney disease.