普罗布考与普伐他汀预防经皮冠状动脉介入治疗后再狭窄的对比研究

Probucol and pravastatin in the prevention of restenosis after percutaneous coronary intervention

目的评价普罗布考预防经皮冠状动脉介入治疗(PCI)后再狭窄的作用。方法将准备行PCI的82例稳定型心绞痛患者随机分为普罗布考组(n=42)和普伐他汀组(n=40)。两组患者于术前4周开始服用普罗布考1 000 mg/d或普伐他汀40 mg/d。服药4周后行金属裸支架置入术。术后继续原剂量及方法服用药物至24周。出院后定期随访,术后24周复查冠状动脉造影。结果PCI后随访至24周,两组严重临床事件发生率(死亡、急性心肌梗死、卒中及紧急血运重建术)差异无统计学意义(P>0.05)。复查冠状动脉造影结果显示普罗布考组再狭窄率(22.5%)低于普伐他汀组(36.8%,P<0.05),普罗布考组管腔直径狭窄率及晚期管腔丢失指数(分别为23.25%±10.08%及0.25±0.41)均低于普伐他汀组(分别为34.76%±16.99%及0.42±0.68,P<0.05),纯获得(2.11±1.02 mm)大于普伐他汀组(1.51±0.96 mm,P<0.05)。而两组晚期管腔丢失比较则差异无统计学意义(P>0.05)。结论PCI前4周应用普罗布考降低PCI后再狭窄率的作用优于普伐他汀。

Objective To evaluate the efficacy of probucol in comparison with pravastatin in the prevention of restenosis in patients with PCI.Methods A total of 82 patients with stable angina pectoris were randomly assigned to either 1000 mg/d of probucol（n=42） or 40 mg/d of pravastatin（n=40） therapy for 4 weeks before PCI.After 4 weeks of premedication,the two groups underwent bare metal stent（BMS） implantation.Probucol and pravastatin were continued until follow-up angiography performed at 24 weeks alter PC1. After discharge, monthly clinical follow-up and angiographic follow-up at 24 weeks were performed. Results By the end of the 24-week-follow-up, comparison of clinical end points （ death, AMI, stroke and emergency revascularization ） between the two groups showed no statistical differences （P 〉 0. 05 ）. Repeat angiography performed 24 weeks after PCI, showed that the restenosis rate was 22.5% in the probucol group and 36. 8% in the pravastatin group （ P 〈 0. 05 ）. The percentage of diameter stenosis （23.25% ±10.08% vs34.76% ±16.99%, P〈0.05） and the late loss index （0.25±0.41 vs 0. 42± 0. 68, P 〈 0. 05 ） in the probucol group were significantly lower than those in the pravastatin group. Net gain in the probueol group was greater than that in the pravastatin group （2. 11 ± 1.02 mm vs 1.51 ±0. 96 mm,P 〈 0. 05 ）. However, late loss between the two groups had no significant difference （P 〉 0. 05 ）. Conclusion Administration of probucol 4 weeks before PCI can reduce the rate of restenosis of BMS in a more extent when compared with pravastatin.