稳定冠心病动脉血浆von Willebrand因子在药物洗脱支架置入前后的变化及意义

Change of von Willebrand factor levels after drug-eluting stents implantation in patients with stable coronary artery disease

目的:比较稳定冠心病患者动脉血浆von Willebrand因子(von Willebrand Factor,v WF)在药物洗脱支架(DES)置入前后的浓度变化,探讨基线v WF水平与心血管事件的关系。方法:入选88例稳定冠心病,收集临床资料。以酶联免疫吸附测定技术测定冠状动脉介入(PCI)前留取的动脉(主动脉根部)血浆v WF。根据基线v WF水平分层,随访1年主要不良心血管事件。29例稳定冠心病患者在DES置入平均8个月后进行了冠状动脉造影复查和v WF测定。结果:DES置入8月后随访v WF浓度明显高于基线水平[(16.47±1.38)ng/ml vs(10.49±1.55)ng/ml,P=0.0067]。平均随访12.5月,v WF高水平组死亡、非致死性冠状动脉综合征、再入院和再次PCI联合终点与低水平组无统计学差异(P=0.179)。结论:稳定冠心病v WF水平与短期内主要不良心血管事件无明显相关;DES置入8个月后v WF水平明显升高,可能与内皮化延迟和内皮功能受损有关。

Objective：The aims of our study were to observe the change of vWF concentration after drug-eluting stents（DES）implantation and to explore the association between baseline vWF levels and short-term outcomes.Method：We conducted a cohort study involving 88 patients with stable coronary artery disease,in our hospital.Data of clinical characteristics,CAG and PCI were collected.Baseline samples（aortic root）for vWF measurement（enzyme-linked immunosorbent assays）were available in total patients.Patients were devided into two groups by vWF levels and followed-up for cardiovascular events including death,ACS,repeated PCI and rehospitalization.After DES implantation,29 patients with stable CAD were measured again.Results：Twenty-nine patients demonstrated significant increase in plasma vWF concentration 8 months after DES implantation（from 10.49±1.55 ng/ml to 16.47±1.38 ng/ml,P=0.0067）.There were no differences for combined endpoints in different vWF level groups.Conclusions：Our study confirms that the arterial plasma vWF level of 8-month DES implantation is higher than that of baseline,and increased vWF levels may be attributed to delayed endothelialization or impaired endothelial function.