血管支架内再狭窄相关因素与机制的研究进展

Progress in the related factors and mechanism of in-stent restenosis

学术背景:血管支架作为一种有效治疗心脑血管硬化手段得到广泛的研究和应用,但血管支架内再狭窄的发生不能避免。因此对血管支架内再狭窄机制的研究就显得尤为必要。目的:阐述血管支架本身及其他相关因素对支架内再狭窄的影响,并提出血管支架内再狭窄机制的传统观点和新观点。检索策略:应用计算机检索PubMed数据库1999-01/2007-07的相关文章,检索词"vascular,mechanism,restenosis,in-stent restenosis(ISR)"并限定文章语言种类为English。同时计算机检索中文科技期刊数据库(中国期刊网CNKI)1999-01/2007-03的相关文章,检索词"血管、机制、再狭窄、支架内再狭窄",限定文章语言种类为中文。对资料进行初审,纳入标准:①血管支架的研究现状。②血管支架内再狭窄机制的研究现状及展望。排除标准:重复性研究。然后查找余下文章的全文,进一步判断与纳入标准一致的文章。同时手工检索有关介入治疗起源与发展的文章3篇。共检索到文献147篇,其中外文138篇,与再狭窄机制研究相关的30篇;中文文献9篇,根据重复文献排除标准,2篇被应用。文献评价:所选用文章32篇,2篇为综述,其余均为临床与实验研究。资料综合:①血管支架的设计、材料及临床应用影响着支架内再狭窄的发生。②内皮细胞功能影响支架内再狭窄的发生。③组织因子的暴露刺激血栓的形成,导致支架内再狭窄。④新生内膜的形成引起支架内再狭窄。⑤支架内再狭窄后期的血管重构进一步促进再狭窄发生。结论:血管支架内再狭窄与多种因素有关,开发良好的新型支架有可能避免和减少再狭窄的发生。

BACKGROUND： Intravascular stent is widely researched and applied as an effective therapeutic tool for angioscleosis. However, the occurrence of in-stent restenosis （ISR） still can＇t be avoided. Therefore, it is urgent to understand the mechanism of ISR. OBJECTIVE： To review the impact of intravascular stent itself and other related factors on ISR, and introduce traditional and new viewpoints of the mechanism of ISR. RETRIEVE STRATEGY： The articles between January 1999 and March 2007 were retrieved from PubMed by using the key words of ＂vascular, mechanism, restenosis, in-stent restenosis＂ and restricting the language as English. Meanwhile, the relevant articles from January 1999 to July 2007 were searched from Chinese Scientific and Technical Periodicals Database by imputing the key words of ＂vascular, mechanism, restenosis, in-stent restenosis＂ in Chinese. The literatures were screened primarily. Inclusive criteria：①the current study of vascular stent;②the current development and prospect of the intravascular ISR mechanism. Exclusive criteria： repetitive researches. Then the full texts from the remaining articles were checked to further judge the articles coincident with inclusive criteria. And 3 literatures about the origin and development of interventional therapy were retrieved manually.A total of 147 literatures were retrieved, including 138 extro-retrieved and 30 literatures of them were about ISR, and 9 internal literatures and 2 literatures of them were collected after those duplicate ones were excluded. LITERATURE EVALUATION： Among 32 selected literatures, 2 of them were reviews and the others were clinical and experimental articles. DATA SYNTHESIS： ①Design, materials and clinical application of intravascular stents affect the occurrence of ISR.② Functions of endothelial cells affect the occurrence of ISR.③ Exposure of tissue factor stimulates formation of thrombus and induces ISR.④Neointimal formation induces ISR.⑤Later vascular remodeling further promotes the occurrence of ISR. CONCLUSION： The mechanism of ISR involves many factors, and the development of new kinds of stent may prevent and decrease the occurrence of ISR.