Rapp J H, Qvarfordt P, Krupski W C, Ehrenfeld W K, Stoney R J
Surgery. 1987 Mar;101(3):277-82.
Cellular proliferation in response to endothelial injury has been examined extensively in experimental animals. Under certain conditions (e.g., hypercholesterolemia and hypertension), this response can be exaggerated and develop into lesions that resemble early atherosclerosis. The injury caused by endarterectomy in human beings and the repair of the arterial wall that ensues may be analogous to the animal models. Presumably, those patients with an exaggerated proliferative response manifest myointimal hyperplasia and recurrent stenosis. To determine potential causes of recurrent stenosis after carotid endarterectomy, we studied 31 patients with early restenosis (group I), 35 patients with later restenosis (group II), and compared them with a control group of 100 consecutive patients who underwent uncomplicated carotid endarterectomy (group III). The known risk factors for atherosclerosis were analyzed. There was no significant difference in the male-to-female ratio, number of cigarettes smoked, or incidence of diabetes mellitus. However, the serum cholesterol level for group I was 282 +/- 57 mg/dl (p less than 0.001 versus controls) while the serum cholesterol level in group II was not significantly elevated over that of the control group. Both groups I and II had a higher incidence of hypertension (p less than 0.005 for both versus controls). There were no differences in the severity of hypertension. The data suggest that hypercholesterolemia has a strong association with early restenosis after carotid endarterectomy but not with late recurrent disease and that hypertension, even when treated, may be associated with both early and late recurrent stenosis.
在实验动物中，已对内皮损伤后的细胞增殖进行了广泛研究。在某些情况下（如高胆固醇血症和高血压），这种反应可能会加剧，并发展成类似早期动脉粥样硬化的病变。人类动脉内膜切除术所造成的损伤以及随后动脉壁的修复可能与动物模型类似。据推测，那些增殖反应过度的患者会出现肌内膜增生和复发性狭窄。为了确定颈动脉内膜切除术后复发性狭窄的潜在原因，我们研究了31例早期再狭窄患者（第一组）、35例晚期再狭窄患者（第二组），并将他们与100例接受了无并发症颈动脉内膜切除术的连续患者组成的对照组（第三组）进行比较。分析了已知的动脉粥样硬化危险因素。男女比例、吸烟数量或糖尿病发病率没有显著差异。然而，第一组的血清胆固醇水平为282±57mg/dl（与对照组相比，p<0.001），而第二组的血清胆固醇水平与对照组相比没有显著升高。第一组和第二组的高血压发病率均较高（两组与对照组相比，p均<0.005）。高血压的严重程度没有差异。数据表明，高胆固醇血症与颈动脉内膜切除术后的早期再狭窄密切相关，但与晚期复发性疾病无关，并且高血压即使经过治疗，可能与早期和晚期复发性狭窄均有关。
