摘要目的 比较老年与年轻冠状动脉粥样硬化性心脏病(冠心病)患者桡动脉形态学差异及内皮型一氧化氮合酶(eNOS)的表达.方法 2008年2月至2009年6月219例应用自体桡动脉行冠状动脉旁路移植术(CABG),其中老年组(≥70岁)57例,年轻组(≤60岁)64例.术前常规行改良Allen试验,阳性患者再以Doppler超声复检.两组患者桡动脉均行HE染色,观测管腔狭窄程度(LN)及内膜/中膜比(IMR);通过免疫荧光染色及Western blot观察eNOS在桡动脉中的定位及表达水平.结果 两组患者桡动脉内膜增生均为轻到中度,中膜未见明显钙化.老年组LN为(22±6)%,年轻组为(23±6)%;老年组IMR为0.36±0.21,年轻组为0.42±0.19;两者组间差异均无统计学意义(P＞0.05).eNOS在桡动脉内膜、中膜均有表达,以中膜平滑肌层为主,相对积分光密度值分析显示老年组桡动脉管壁eNOS表达含量为1.21±0.13,年轻组为1.25±0.12,组间差异无统计学意义(P＞0.05).结论经过改良Allen实验及Doppler超声筛选后,老年冠心病患者桡动脉的质量及功能与年轻患者相近,应用于CABG有望获得较高的远期通畅率.

abstractsObjective To compare the morphometry and endothelial nitric oxide synthase (eNOS) expression of radial artery ( RA) between young and elderly patients with coronary atherosclerotic heart disease. Methods From February 2008 to June 2009, 219 patients underwent coronary artery bypass grafting (CABG) with autologous RA, 57 patients aged beyond 70 years and 64 patients aged under 60 years. Before RA was harvested, a modified Allen test was routinely performed. If positive, RA would be further evaluated with Doppler ultrasound examination. In both groups RA was collected for HE staining to evaluate percentage of luminal narrowing ( LN ) and relationship between intima and media width at maximum intimal thickness (IMR). Immunofluorescence and Western blot were used to investigate the location and expression level of eNOS within the wall of RA. Results Morphometry of RA in both young and elderly patients represented mild or moderate intimal hyperplasia, and medial calcification was not found. LN in elderly patients was(22±6)%,while in young patients,it was(23±6)%.IMR in elderly patients was 0.36±0.21.while in young patients,it was 0.42±0.19.There was no significant difierence in both LN and IMR between two groups(P＞0.05).Immunofluorescence indicated RA in both groups revealed a high expression of eNOS in intima and media.particularly in the smooth muscle of media.The values of relative integrated optical density in elderly patients was 1.21±0.13,while in young patients,it was 1.25±0.12 Also there was no significant difference in the expression level of eNOS within the wall of RA(P＞0.05).Conclusion After preoperative assessment with modified Allen's test and Doppler analysis.RA used as graft in the elderly has similar quality and function with young patients,and it may lead to a hish patency in long term.