冠状动脉支架置入术后早期血管损伤的变化

Clinical study of early injury of coronary artery after percutaneous transluminal coronary stent implantation

目的:观察冠状动脉支架置入术后早期血管损伤的变化情况,探讨冠状动脉支架置入术后再狭窄的机制。方法:选择经冠状动脉造影检查证实为冠心病的患者,随机分为支架组(30例)及对照组(30例)。2组患者均于冠状动脉支架置入或冠状动脉造影术前后采集肘静脉血,检测内皮素-1(ET-1)、P-选择素(PS)、纤维蛋白原(Fbg)、CD11b的水平,并进行统计学分析。结果:①支架组中ET-1、PS在术后0.5h上升至高峰,Fbg、CD11b在术后1d达到高峰;与术前当天及对照组比较,均差异有统计学意义(P<0.01)。②术前水平与术后高峰的差值在ET-1、Fbg、CD11b两两之间呈正相关,年龄及支架长度与ET、Fbg、CD11b术后高峰水平之间无相关性。结论:支架置入术后早期出现了明显的血管损伤反应,伴随着显著的血小板活化及一过性的凝血功能亢进,并诱发了明显的局部炎症反应。

Objective：The present study was conducted to explore the mechanism of restenosis after percutaneous transluminal coronary stent implantation by observing early injury reaction of coronary artery and to provide evidence and reference in clinic for diagnose、prevent and treat restenosis after percutaneous coronary intervesion.Method：Patients with at least 50% percent coronary stenosis proved by coronary arteriography were involved and randomly divided into two groups,as percutaneous coronary intervesion （PCI） group （30 patients） and coronary angiography （CAG） group （30 patients）.Serum ET-1,PS,Fbg,CD11b of leukocyte were tested at perioperation.The change tendency of variables was observed and their difference between each groups was analyzed.Result：①The level of ET-1,PS at half an hour after operation in PCI group were significant difference compared to those of in the control group and those before operation （P0.01）.The change of Fbg was similar at 1 day after operation.The level of CD11b of leukocyte began to rise at half an hour after the operation and reached the peak at 1 day after the operation in PCI group.②The difference between pre-and post operation were positively correlated among ET-1,PS,Fbg,CD11b of leukocyte.And the peak level of these variables were was not correlated to age and or the mean stent length.Conclusion：These findings suggest that PCI causes remarkably endothelial injury and activation of hematological system and also triggers inflammatory reaction at early period.Detection of the level of ET-1,PS,Fbg,CD11b of leukocyte is helpful to observe early injury of coronary artery after percutaneous transluminal coronary stent implantation from the aspect of endothelial injury、activation of hematological system and inflammatory reaction.