Результаты операции ТМЛР в сочетании с введением ангионенных факторов у больных ИБС с поражением дистального русла тема диссертации и автореферата по ВАК РФ 14.00.44, кандидат медицинских наук Сарджвеладзе, Эдуард Годердзиевич

  • Сарджвеладзе, Эдуард Годердзиевич
  • кандидат медицинских науккандидат медицинских наук
  • 2008, Обнинск
  • Специальность ВАК РФ14.00.44
  • Количество страниц 150
Сарджвеладзе, Эдуард Годердзиевич. Результаты операции ТМЛР в сочетании с введением ангионенных факторов у больных ИБС с поражением дистального русла: дис. кандидат медицинских наук: 14.00.44 - Сердечно-сосудистая хирургия. Обнинск. 2008. 150 с.

Оглавление диссертации кандидат медицинских наук Сарджвеладзе, Эдуард Годердзиевич

Список сокращений Введение

Глава

I. Обзор литературы

1. Терапевтический ангиогенез

1.1. Общие сведения о терапевтическом ангиогенезе

1.2. История вопроса

1.3. Чего мы хотим достичь терапевтическим ангиогенезом

1.4. Стимулы и механизмы неоваскуляризации

1.5. Выбор терапевтического агента

1.6. Доставка ангиогенных агентов

1.7. Комбинация факторов роста и основные гены переключатели

1.8. Завершенные клинические исследования

2. Трансмиокардиальная лазерная реваскуляризация

2.1. Исторические предпосылки

2.2. Лазеры для реваскуляризации миокарда

2.3. Современные представления о механизмах эффективности ТМЛР

3. Клинические результаты: симптоматика, перфузия, функция и выживаемость А. Рандомизированные и большие клинические исследования изолированной ТМЛР Б. Исследование результатов ТМЛР в сочетании с АКШ

Глава

II. Клинический материал и методы исследования

2.1. Общая клиническая характеристика больных

2.2. Методики исследования

2.2.1. Электрокардиографическое исследование

2.2.2. Холтеровское мониторирование

2.3. Эхокардиографическое исследование

2.2.4. Велоэргометрическое исследование

2.2.5. Стресс Эхокардиографическое исследование

2.2.6. Коронароангиография

2.2.7. Левая вентрикулография

2.2.8. Радионуклидные методы исследования

2.2.8.1 ЭКГ-синхронизированная томосцинтиграфия (Gated-SPECT) миокарда (синхро-ОФЭКТ)

2.2.8.2. Позитронно-эмиссионная томография миокарда (ПЭТ)

2.3. Оценка качество жизни

2.4. Лазерные установки

2.5. Сведения о препарате a-ECGF

2.5.1. Структура a-ECGF

2.5.2. Производство и очищение a-ECGF

2.5.3. Проба на хориоаллантоидной мембране

2.5.4. Исключение пирогенности a-ECGF

2.5.5. Подтверждение ангиогенного потенциала a-ECGF в экспериментах на животных

2.5.6. Фармакологическая безопасность

2.6. Статистическая обработка

Глава

III. Сравнение результатов в группах ТМЛР в сочетании с введением фактора роста эндотелиальных клеток (a-ECGF) и Placebo у больных ИБС с конечной стадией поражения коронарных артерий

3.1. Обсуждение результатов

Глава

IV. Сравнение результатов в группах с изолированной ТМЛР, ТМЛР+АКШ, ТМЛР+МИРМ

4.1. Перфузия: общие данные и динамика изменений по срокам обследования больных

4.2. Обсуждение результатов

Заключение

Рекомендованный список диссертаций по специальности «Сердечно-сосудистая хирургия», 14.00.44 шифр ВАК

Введение диссертации (часть автореферата) на тему «Результаты операции ТМЛР в сочетании с введением ангионенных факторов у больных ИБС с поражением дистального русла»

Сердечно-сосудистая хирургия —14.00.44

Диссертация на соискание степени кандидата медицинских наук Научный руководитель академик РАМН, проф. Л.А. Бокерия

Москва - 2008

ОГЛАВЛЕНИЕ.

Список сокращений 4

Введение 6

Похожие диссертационные работы по специальности «Сердечно-сосудистая хирургия», 14.00.44 шифр ВАК

Заключение диссертации по теме «Сердечно-сосудистая хирургия», Сарджвеладзе, Эдуард Годердзиевич

выводы.

1. Ангиогенные факторы a-ECGF в течение первого месяца вызывает выраженный ангиогенез, достоверно определяющийся по показателям перфузии во всех группах.

2. Длительность улучшения перфузии под воздействием АФ не превышает 1 месяц.

3. Для закрепления ангиогенного эффекта a-ECGF необходимо длительное (многократное) введение препарата.

4. Комбинированное использование a-ECGF с ТМЛР позволяет улучшить перфузию миокарда в сроки, когда эффект собственно ТМЛР еще не проявляется. Поэтому такое комбинированное лечение эффективно в критические для ТМЛР сроки.

5. Использование альфа ECGF в качестве одного болюса с целью индукции ангиогенеза у больных с хронической ИБС в длительные сроки не эффективно.

Практические рекомендации:

1. Поскольку сочетанное применение ангиогенного фактора альфа ECGF с TMJIP позволяет улучшить перфузию миокарда в критические собственно для ТМЛР сроки (1-3 месяца), возможно, такое сочетание может стать альтернативой лечению больных ИБС с поражением дистального русла только с помощью изолированной ТМЛР.

2. Самостоятельное применение ангиогенного фактора в виде одного боллюса не эффективно и поэтому не может быть рекомендовано в качестве самостоятельной формы лечения больных ИБС с поражением дистального русла.

3. Поэтому необходим поиск методов, обеспечивающих продление эффективности ангиогенных факторов.

4. Этот поиск надлежит продолжить в двух направлениях: а). Определение путей доставки ангиогенных факторов в сектора-мишени; б). Использование их на биодеградирующей основе.

5. Возможно, эффективным окажется использование комбинации сочетания факторов роста.

6. Введение ангиогенных факторов в миокард, очевидно, целесообразно осуществлять не в виде одного болюса, в дробных порциях.

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