Late Graft Disease Research Articles

Association between proprotein convertase subtilisin/kexin type 9 and late saphenous vein graft disease after coronary artery bypass grafting: a cross-sectional study

目的 探讨冠状动脉旁路移植术(CABG)后血清前蛋白转化酶枯草溶菌素9(PCSK9)与隐静脉移植血管疾病(SVGD)的关系。 研究设计 一项横断面研究。 研究地点 中国天津市1所二级医院。 研究对象 总计231名患者参与该研究。入选标准如下：年龄≥18岁；CABG术后12个月以上；至少含有1支SVG，非侵入性检查结果异常或复发稳定型心绞痛有冠脉造影指征；愿意参与研究并签署知情同意书。存在以下任何一种情况的患者予以排除：先天性心脏瓣膜病、失代偿性心力衰竭、贫血(定义为女性血红蛋白水平<12 g/dl或男性血红蛋白水平<13 g/dl)、恶性肿瘤、肾功能衰竭、严重肝脏疾病、甲状腺疾病、急性或慢性炎症性疾病和慢性阻塞性肺部疾病。 主要结果测量 SVGD被定义为至少1支SVG狭窄≥50%。应用ELISA试剂盒并根据制造商提供的说明书测定循环PCSK9浓度。 结果 SVGD组平均PCSK9水平显著高于非SVGD组(275.2±38.6比249.3±37.7，P<0.01)。多因素回归模型显示血清PCSK9每增加1个标准差，SVGD发生风险显著增加(比值比2.08，95%可信区间1.46~2.95)。 结论 本研究在调整了确定的心血管危险因素后，首次确定PCSK9与晚期SVGD之间独立相关。未来需多中心大样本的前瞻性队列研究来进一步探究它们之间的关系。

Evaluation of serum levels of solubilized adhesion molecules in patients with aortocoronary saphenous vein grafts

To assess the diagnostic importance of serum-solubilized adhesion molecules, vascular cell adhesion molecule-1, intercellular adhesion molecule-1, sE-selectin and sP-selectin in aortocoronary saphenous vein graft disease. The study population was composed of two groups consisting of 41 patients with saphenous vein graft stenosis (stenosis group) and 43 patients without saphenous vein graft stenosis (no-stenosis group) based on the results of coronary angiography. All patients underwent coronary artery bypass graft operation involving the use of at least one saphenous vein graft for bypass. At the time of cardiac catheterization, it had been more than 1 year since the operation. Serum level of sP-selectin was significantly higher in the stenosis group than in the no-stenosis group (72.9+/-21.7 versus 48.7+/-18.6 ng/ml, P<0.001). No differences were found between the two groups with respect to serum levels of sE-selectin, intercellular adhesion molecule-1 and vascular cell adhesion molecule-1. Multivariate analysis revealed that only serum levels of sP-selectin, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were independently correlated with the stenosis of saphenous vein grafts. A cutoff value of serum sP-selectin >57.5 ng/ml yields a specificity of 79.5%, a sensitivity of 73.3% and a positive predictive value of 80.5% for saphenous vein graft stenosis. In this study, sP-selectin level was found to be significantly higher in the group that had late aortocoronary saphenous vein bypass graft disease. This result suggests that platelet activation may play a causal role in late graft disease.