药物洗脱支架:较强安全性和良好近远期效果之评价

Drug-eluting stent:Evaluation of safety,short-and long-term effect

目的:评价冠状动脉介入治疗中应用药物支架置入后的效果、安全性。方法:以"经皮冠状动脉成形术,药物血管支架,内膜增生,再狭窄,生物相容性"为关键词,采用计算机检索2000-01/2009-12相关文章。纳入与血管支架材料,血管支架材料改性相关的文章,排除重复研究或Mata分析类文章,以14篇为重点,讨论载药支架对血管内皮增生、再狭窄及生物相容性的影响。结果:药物支架具有在血管病变部位将药物自聚合物涂层中通过洗脱方式有控制的释放至心血管壁组织而发挥生物学效应的特点。以雷帕霉素洗脱支架为代表的药物支架在冠状动脉粥样硬化性心脏病(冠心病)的介入治疗中,有效降低了支架内再狭窄和心血管事件的发生率,对糖尿病患者、小血管病变、冠状动脉长病变和弥漫性复杂病变治疗方面也显示出良好的疗效。文献还显示国产雷帕霉素洗脱支架与进口雷帕霉素洗脱支架相比同样具有良好的安全性,但由于支架携带的药物本身和承载药物的涂层作用,是否会引起晚期支架内血栓引起了临床的重视,科研人员也在通过对支架晚期支架内血栓机制、可控血栓危险因素的干预策略和支架工艺技术的研究,积极探索新一代的既减少支架再狭窄又减少支架血栓更安全的药物洗脱支架。结论:以雷帕霉素洗脱支架为代表的药物支架在多种冠心病的介入治疗中,能有效降低支架置入后血管内再狭窄和心血管事件的发生率,有较强的安全性和良好的近远期疗效。

OBJECTIVE：To evaluate the effect and safety of drug-eluting stent implantation in coronary artery interventional therapy.METHODS：With key words ＂percutaneous transcoronary angioplasty,drug intravascular stent,intimal hyperplasy,restenosis,biocompatibility＂,a computer-based online search was performed for articles published between January 2000 and December 2009.Articles correlated with intravascular stent materials,intravascular stent material modification were included.Repetitive studies or Meta analysis was excluded.Finally,14 articles were included,and influence of drug-eluting stent on blood vessel endothelium hyperplasy,restenosis,and biocompatibility was discussed.RESULTS：Drug-eluting stent can control release of drug from polymer coating to vascular lesion sites by eluting pattern.For example,rapamycin-eluting stent effectively reduces incidence of restenosis and cardiovascular events in treating coronary atherosclerotic heart disease,and displays favorable effects in treating diabetes,small vessel disease,coronary artery long lesions and diffuse complex lesion.In addition,domestic rapamycin-eluting stent shows safety compared with foreign stent.However,it has been paid attention whether the interaction of drug-eluted by the stent and the coating can induce thrombus in the stent.Researchers have studied the thrombus mechanism at late stage,intervention of thrombus risks and stent technology to explore safe drug-eluting stent that can reduce restenosis and in-stent thrombus.CONCLUSION：Drug-eluting stent,such as rapamycin-eluting stent,effectively reduces incidence of restenosis and cardiovascular events in treating coronary atherosclerotic heart disease,with safety and short-and long-term effect.