西洛他唑预防糖尿病冠心病金属裸支架术后再狭窄的效果

Study of using cilostazol for preventing restenosis after stenting in patients with diabetes mellitus

目的观察服用西洛他唑预防糖尿病冠心病金属裸支架术后再狭窄的疗效。方法2004年3月至12月我院收治的157例有糖尿病的冠心病患者,择期植入金属裸支架治疗,术后把患者随机分为两组,治疗组每天服用西洛他唑200mg、阿司匹林100mg和氯吡格雷75mg;氯吡格雷组每天服用阿司匹林100mg和氯吡格雷75mg。持续服用6个月,主要测量血管造影:植入金属裸支架的病变处最小腔内直径(MLD)。其次观察临床不良心脑血管事件(MACCE):死亡、非致死性急性心肌梗死、靶血管重建、脑卒中、急性、亚急性血栓,以及出血等不良事件的发生率。结果6个月时冠状动脉造影随访,西洛他唑组MLD明显大于氯吡格雷组(2·48mmvs1·94mm,P<0·05);再狭窄率(13·1%vs35·3%,P<0·05)明显低于氯吡格雷组。两组的主要心脑血管事件及出血不良事件比较差异无显著性(P>0·05)。结论有糖尿病的冠心病金属裸支架术后应用西洛他唑可减少金属裸支架术后再狭窄率,增加随访期的MLD,而没有增加出血并发症,临床应用安全有效。

Objective To evaluate of the outcomes of using cilostazol for preventing restenosis within stents in diabetic patients. Methods 157 diabetic patients who underwent elective stenting were randomly assigned to group of cilostazol 200 mg/d plus clopidogrel 75 mg/d plus aspirin 100 mg/ d （cilostazol group） and group of clopidogrel 75 mg/d plus aspirin 100 mg/d（clopidogrel group）. Follow-up coronary angiography was performed 6 months after the administration. Minimum lumen diameter （MLD） was tested. Secondary end points were the major cardiac event （MACE）, including death, AMI, target vessel revascularization and bleeding event. Results At follow-up angiography the minimum lumen diameter was larger in cilostazol group compared with clopidogre group （2. 48 vs 1.94 mm, P〈0. 05）. Restenosis rate was lower in cilostazol group （13.1% vs 35. 3%; P〈0. 05） than in clopidogre group. Two groups were same at the major cardiac event and bleeding event （P〉 0. 05）. Conclusions After stenting, the cilostazol treatment reduces restenosis and increases MLD at 6 months of follow-up angiography. The clinical application is effective and save.