冠状动脉支架置入后靶血管病变与C-反应蛋白变化

Target vessel lesions and C-reactive protein following coronary stent implantation

背景:冠状动脉粥样硬化的形成和发展与炎症反应密切相关,C-反应蛋白是一项反映机体炎症反应的敏感指标,可用于预测临床预后。目的:探讨冠状动脉粥样硬化性心脏病患者行冠状动脉支架置入前血浆C-反应蛋白水平对靶血管病变的预测价值。设计:回顾性病例分析。对象:选择2005-03/2007-03解放军第三○五医院住院的单支或多支血管病变患者82例,稳定型心绞痛30例,急性冠状动脉综合征52例,均符合WHO冠状动脉粥样硬化性心脏病的诊断标准。方法:所有患者均接受单支血管经皮冠状动脉心血管支架置入,置入前采血测定基础血浆C-反应蛋白水平,根据具体值将患者分为C-反应蛋白<3.0mg/L33例和C-反应蛋白≥3.0mg/L49例。置入后12个月复查冠状动脉造影,支架内及支架两端5mm范围内管腔直径丢失≥50%为支架内再狭窄,其他部位新出现的病变使管腔狭窄≥30%为新生血管病变。主要观察指标:支架内再狭窄及靶血管病变与C-反应蛋白水平的关系。结果:C-反应蛋白<3.0mg/L的33例患者支架内再狭窄率为6.1%,显著低于C-反应蛋白≥3.0mg/L的49例患者支架内再狭窄率18.4%(P<0.01)。C-反应蛋白<3.0mg/L的33例患者靶血管新生病变率为3.0%(1/33),亦明显低于C-反应蛋白≥3.0mg/L的49例患者靶血管新生病变率6.1%(P<0.05)。结论:经皮冠状动脉心血管支架置入前基础C-反应蛋白水平与置入后1年支架内再狭窄及靶血管新生病变的发生呈正相关。

BACKGROUND： Coronary atherosclerosis formation and progression is closely related with inflammation. C-reactive protein （CRP） is a sensitive index that can reflect body inflammatory reactions, which can be used to predict clinical prognosis. OBJECTIVE： To investigate the value of plasma CRP before surgery in predicting target vessel lesions after coronary stent implantation. DESIGN： Retrospective case analysis. PARTICIPANTS： Eighty-two cases including 30 of stable angina pectoris and 52 of acute coronary syndrome were selected from the 305 Hospital of Chinese PLA between March 2005 and March 2007, which were confirmed by the diagnostic criteria of WHO for coronary atherosclerotic heart disease. METHODS： All patients underwent percutaneous coronary stent implantation. Plasma CRP levels were measured before implantation. According to the level of CRP, the patients were divided into two groups： CRP 〈 3.0 mg/L （n=33） and CRP≥ 3.0 mg/L （n=49）. The in-stent restenosis and target vessel new lesions were observed at 12 months after the procedure by coronary angiograph （restenosis was defined as loss of lumen diameter ≥ 50%; new lesions defined as loss of lumen diameter≥ 30%）. MAIN OUTCOME MEASURES： Relationship of in-stent restenosis and new lesions with CRP levels. RESULTS： The ratio of in-stent restenosis was significantly higher in CRP≥ 3.0 mg/L patients than in CRP 〈 3.0 mg/L patients （18.4%, 6.1%; P 〈 0.01）. The rate of target vessel new lesions was significantly higher in CRP≥ 3.0 mg/L patients than in CRP 〈 3.0 mg/L patients （6.1%, 3.0%; P 〈 0.05）. CONCULSION： Plasma CRP levels before percutaneous coronary stent implantation exhibits a positive correlation with incidence of in-stent restenosis and new lesions at 1 year after stents implantation.