置入心血管支架后冠状动脉粥样硬化性心脏病患者的C-反应蛋白变化

C-reactive protein changes in coronary artery disease patients following cardiovascular stent implantation

背景:心血管支架作为一种异体物质,置入后存在明显的炎症反应过程,主要表现在凝血系统的激活以及炎性标志物血清C-反应蛋白的显著升高。目的:总结探讨支架置入后冠状动脉粥样硬化性心脏病患者炎症反应及C-反应蛋白的变化。方法:应用计算机检索中文期刊全文数据库1990/2009相关文献,检索词为"心血管支架,C-反应蛋白,炎症反应",同时检索PubMed数据库1990/2009相关文献,检索词为"cardiovascular stent on plasma,c-reactive protein"。结果与结论:药物涂层支架以金属支架为载体携带药物到达血管损伤局部,使药物在较长的时间内充分释放到血管壁内,减少支架置入后再狭窄的发生。抗炎药物涂层支架主要药物为地塞米松、甲泼尼龙等。抗迁移、抗增生药物涂层支架主要药物为雷帕霉素、紫杉醇、放线菌素D等。支持内膜愈合的药物涂层支架主要药物为雌二醇等。经皮冠状动脉支架置入可诱导和加重局部炎症反应,这对血管内皮的增生与再狭窄有重要影响。反映急性炎症反应的敏感指标如血清C-反应蛋白的浓度对于经皮冠状动脉支架置入后心血管事件的发生有预测价值。冠状动脉内支架置入可显著升高血浆C-反应蛋白水平,所以应充分认识炎症反应及血浆C-反应蛋白、细胞因子的变化对防止心血管支架置入后再狭窄起到的重要作用,及早进行预防及干预,从而减少再狭窄率,提高介入治疗效果。

BACKGROUND： The inflammatory reaction occurs following implantation of cardiovascular stent with manifestations of the activation of blood coagulation system and dramatically increasing of inflammatory markers serum C-reactive protein. OBJECTIVE： To explore the changes of inflammatory reaction and C-reactive protein in coronary artery disease patients following cardiovascular stent implantation. METHODS： A computer-based online search of CNKI （1990/2009） and PubMed databases （1990/2009） was performed for related articles with the key words ＂cardiovascular stent , C-reactive protein＂ in Chinese and ＂cardiovascular stent on plasma, C-reactive protein＂ in English. RESULTS AND CONCLUSION： Based on the metal stents, drug-eluting stents can transfer the active drugs to the damaged vessels, release them into the vascular wall and inhibit the in-stent restenosis. Main drugs of anti-inflammatory drug-eluting stent include dexamethasone and methylprednisolone. Main drugs of anti-migratory and anti-proliferative drug-eluting stent include rapamycin, paclitaxel and actinomycin D. Main drugs of supporting intima concrescence stent include estradiol. Coronary artery stents implantation can induce and aggravate local inflammation reaction, which have important infection for vascular endodermis hyperplasia and restenosis occurrence. Some impressible index for inflammation reaction, such as levels of C-reactive protein, have predictive value for vascular events following the coronary artery stents implantation. A significant increase in plasma C-reactive protein after coronary stenting has been observed following stent implantation. Therefore, understanding of inflammatory reaction and C-reactive protein, as well as cytokine changes is important for preventing restenosis, early treatment of restenosis, as well as improving treatment effect.