冠心病支架内再狭窄患者血浆脂联素水平的观察

Association between plasma adiponectin level and in-stent restenosis after coronary stenting

目的观察冠心病患者支架置入术后再狭窄与血浆脂联素水平之间的关系。方法对65例支架置入术后9～12个月无支架内再狭窄（A组）和54例存在支架内再狭窄≥50％（B组）的冠心病患者进行研究，复查冠状动脉造影当天取空腹12h以上的股动脉血，采用ELISA法测定血浆脂联素水平；同时对支架置入前、置入术后即刻及9～12个月后的冠状动脉造影结果进行QCA评价。结果A、B两组的靶血管病变部位及病变的复杂程度均相似，使用金属裸支架分别为8例（12．31％）和6例（11．11％）；使用紫杉醇药物洗脱支架分别为11例（16．92％）和10例（18．52％）；使用雷帕霉素药物洗脱支架分别为46例（70．77％）和38例（70．37％），术后用药两组之间无明显差异。A组脂联素水平明显高于B组[（15．16±5．02）mg／L比（10．01±4．93）mg／L，P〈0．05]；两组的病变长度相似[（15．82±6．67）mm比（13．40±4．20）mm，P〉0．05]；术前及术后即刻的最小管腔直径（MLD）、狭窄程度两组差异无统计学意义（P〉0．05），但9～12个月时的QCA显示：A组的MLD为（2．55±0．53）mm，平均狭窄程度为（24．21±11．23）％，B组的MLD为（0．57±0．60）mm，平均狭窄程度为（81．00±19．11）％，P〈0．01；即刻获得的管腔直径两组间比较无统计学意义[（1．48±0．65）mm比（1．19±0．37）mm，P〉0．05]；A组的晚期丢失明显小于B组[（0．50±0．34）mm比（1．60±0．54）mm，P〈0．01]。结论血浆脂联素水平降低可能是支架术后再狭窄的原因之一。

Objective The purpose of the present study was to identify the relationship between the plasma level of adiponeetin and in-stent restenosis of patients with coronary heart disease after coronary stenting. Method The study population comprised 119 individuals （92 men ） who underwent stent implantation, including 65 subjects without in-stent restenosis （group A ） and 54 patients with in-stent restenosis （group B）. The level of plasma adiponectin was measured using ELISA. Coronary angiography was performed immediately before and after implanting stent and 9 - 12 months later. Results Baseline characteristics including drug use after PC] were similar between the groups. The rate of implanting bare metal stent is 8 （ 12. 31% ） ancl 6 （ 11.11% ）, TAXUS drug-eluting stent is 11 （ 16： 92% ） and 10 （ 18.52% ） and CYPHER drug-eluting stent is 46 （70. 77% ） and 38 （ 70. 37% ） respectively （ all P 〉 0. 05 ）. Plasma level of adiponectin in patient of group A was significantly higher than that in group B [ （ 15.16 ± 5.02 ） mg/L vs. （ 10. 01±4. 93 ） mg/L, P 〈 0. 05 ]. The quantitative coronary angiography （QCA） showed that lesion length was similar between groups [ （ 15. 82 ± 6. 67 ）mm vs. （ 13.40 ± 4. 20 ）mm, P 〉 0. 05 ], minimum lumen diameter（MLD） and stenosis rate were also similar before and after implanting stent （P 〉0. 05） and acute gain was （ 1.48± 0. 65 ）mm vs. （ 1.19± 0. 37 ） mm （ P 〉 0. 05 ）. MLD was higher in group A than that in group B [ （2. 55 ±0. 53）mm vs. （0. 57 ±0. 60）mm, P 〈0. 01 ] at 9 - 12 months follow up. Restenosis rate [（24.2±11.2）% vs. （81.0±19.1）%,P〈0.01] and late lumen loss [（0.50±0.34）mm vs. （ 1.60 ±0. 54） ram, P 〈 0. 01 ] were lower in group A than in group B. Conclusions The lower plasma adiponectin level might be associated with in-stent restenosis after coronary stenting.