两种药物洗脱支架对冠状动脉内皮功能影响的比较研究

Effect of drug-eluting stent on coronary endothelial function

目的探讨两种药物洗脱支架(DES)对冠状动脉血管内皮功能的影响。方法 2009年3月至2010年3月拟行冠状动脉内单支架植入术的患者66例,随机分为紫杉醇药物洗脱支架组(PES组)、西罗莫司药物洗脱支架组(SES组)各33例。利用定量冠状动脉造影(QCA)测量术后即刻、术后6个月冠状动脉内灌注乙酰胆碱(Ach)、硝酸甘油的造影结果,通过对支架远端5～20mm冠状动脉血管段分析来评估内皮依赖性的血管扩张反应与非内皮依赖性的血管扩张反应。结果入选66例患者均接受临床随访(100%)。55例患者(83.3%)接受冠状动脉造影随访,9例患者拒绝冠状动脉造影随访,其中PES组4例,SES组5例;PES组1例发生支架内再狭窄(3.0%),SES组1例发生支架内再狭窄(3.0%),均被排除,最后对55例患者(83.3%)进行统计学分析。术后6个月Ach灌注激发内皮依赖性血管舒张功能PES组显著低于SES组[(-30±2)%vs.(-24±3)%,P<0.05)],术后6个月两组间非内皮依赖性血管舒张功能差异无统计学意义(P>0.05)。结论植入DES后影响冠状动脉内皮依赖性血管舒张功能,PES较SES显著。

Objective To explore coronary endothelial function in patients with drug-eluting stent implantation.Methods From March 2009 to March 2010,66 patients with single stent implantation(33 in PES,33 in SES)were enrolled in this prospective study.Endothelium-dependent vasomotion and endothelium-independent vasomotion after intracoronary infusion of acetylcholine and nitroglycerin in a coronary segment 15 mm in length,starting 5 mm distal to the stent,were assessed with quantitative coronary angiography(QCA)post-procedure and at 6-month follow-up after the procedure.Results Clincal follow-up was available in 66 patients(100%).Angiographic was available in 55 patients(83.3%),nine patients refused reangiography (4 PES patients,5 SES patients),and two patients showed in-stent restenosis at 6-month follow-up(1 in PES,1 in SES) were excluded from QCA analysis.Compared to SES group,PES group had lower value of endothelium-dependent vasomotion at 6-month follow-up [(-30±2)% vs.(-24±3)%,P<0.05],without significant difference in endothelium-independent vasomotion (P>0.05).Conclusions Coronary endothelial function was impaired significantly after drug-eluting stent implantation,with more profound damage in the PES group.