药物洗脱支架与金属支架置入后再狭窄及其生物相容性比较

Comparison of restenosis and biocompatibility between drug eluting stent and metal stent following implantation

目的:比较并总结金属裸支架与药物洗脱支架的生物相容性及支架置入后的冠状动脉再狭窄,展望生物可降解支架的临床应用。方法:以药物洗脱支架,金属裸支架,生物相容性,再狭窄为检索词,检索中国期刊全文数据库(1999-01/2009-06),以drugelutingstent,baremetalstent,biocompatibility,restenosis为检索词,检索PubMed数据库(1999-01/2009-06),文献检索语种限制为中文和英文。以再狭窄率,支架的生物相容性及炎症因子的表达为评价指标。纳入药物洗脱支架与金属支架置入后血管再狭窄的临床研究;排除动物实验。结果:计算机初检得到523篇文献,根据纳入排除标准,对金属裸支架与药物洗脱支架置入后血管再狭窄的临床研究进行分析。经皮冠状动脉支架置入已成为治疗冠状动脉粥样硬化性心脏病最常用的治疗方法,其主要包括球囊扩张、普通金属裸支架置入、药物洗脱支架置入。用普通金属裸支架取代球囊扩张,使支架内再狭窄由50%下降到20%～30%;药物洗脱支架改善了冠状动脉介入治疗的愈后,但同时也带来了许多新问题。大多数药物洗脱支架由药物、药物载体、支架平台3部分组成,其中金属支架和聚合物不能被人体吸收。金属置入物和药物载体长期存留于血管中,影响内皮化、引起局部的慢性炎症反应和后期的血栓形成。结论:药物洗脱支架在防止支架内再狭窄及再次血运重建明显优于普通金属裸支架。生物可降解支架的临床应用,在一定程度上减少了药物载体对血管内皮的影响。

OBJECTIVE： To compare the biocompatibility, as well as restenosis following drug eluting stent and metal stent implantation, in addition, to prospect the clinical application of biodegradable stent. METHODS： Chinese Journal Full-Text Database and Pubmed were retrieved with key words of drug eluting stent, bare metal stent, biocompatibility, and restenosis, from January 1999 to June 2009. The language was restricted within Chinese and English Simultaneously, restenosis, biocompatibility and inflammatory factor expression was acted as evaluation index. Accordingly, clinical research concerning restenosis following stent implantation was included. The animal experiment was excluded. RESULTS： A total of 523 literatures were obtained by initial search with computer. According to inclusion criteria, the related papers were analyzed. Percutaneous transluminal coronary stenting is the major treatment for coronary atherosclerotic heart disease, which comprises balloon dilation, bare metal stenting, and drug eluting stent implantation. When balloon dilation was replaced by bare metal stenting, the restenosis rate was reduced from 50% to 20%-30%. The drug eluting stent composed of drug, drug carrier, and scaffold, which ameliorate healing following coronary intervention. However, the non-degradable stent remained in the blood vessel for a long time, which effected endothelialization and resulted in chronic inflammatory reaction, as well as thrombosis following implantation. CONCLUSION： The drug eluting stent exhibits superiority in preventing restenosis and repeat revascularization than bare metal stent. Furthermore, the application of biodegradable stent reduces the effect of drug carrier on blood vessel endothelium.