Shen Liu-zhong, Chen Xu-jun, Chen Xin, Xu Ming, Wang Li-ming, Jiang Ying-shuo
Department of Thoracic and Cardiovascular Surgery, Nanjing Medical University, Nanjing 210006, China.
Zhonghua Wai Ke Za Zhi. 2010 Jun 1;48(11):825-9.
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.
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.
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 difference 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).
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 high patency in long term.
比较年轻和老年冠心病患者桡动脉（RA）的形态学及内皮型一氧化氮合酶（eNOS）表达。
2008年2月至2009年6月，219例行自体RA冠状动脉旁路移植术（CABG）的患者，其中57例年龄超过70岁，64例年龄在60岁以下。在获取RA前，常规进行改良艾伦试验。若结果为阳性，则用多普勒超声检查进一步评估RA。两组均采集RA进行苏木精-伊红（HE）染色，以评估管腔狭窄百分比（LN）及最大内膜厚度处内膜与中膜宽度的关系（IMR）。采用免疫荧光和蛋白质印迹法研究RA壁内eNOS的定位和表达水平。
年轻和老年患者RA的形态学均表现为轻度或中度内膜增生，未发现中膜钙化。老年患者的LN为（22±6）%，而年轻患者为（23±6）%。老年患者的IMR为0.36±0.21，年轻患者为0.42±0.19。两组间LN和IMR均无显著差异（P>0.05）。免疫荧光显示两组RA的内膜和中膜，尤其是中膜平滑肌中eNOS表达较高。老年患者的相对积分光密度值为1.21±0.13，年轻患者为1.25±0.12。RA壁内eNOS的表达水平也无显著差异（P>0.05）。
经改良艾伦试验和多普勒分析进行术前评估后，老年患者作为移植物的RA与年轻患者具有相似的质量和功能，长期通畅率可能较高。
