冠心病合并2型糖尿病患者置入雷帕霉素药物洗脱支架远期疗效及斑块稳定性分析

Long-term Outcomes and Activity of Risk Biomarkers after Sirolimus-eluting Stent Implantation for Patients with Diabetes Mellitus

目的观察冠心病合并糖尿病患者置入雷帕霉素药物洗脱支架后的远期疗效及斑块稳定性分析。方法入选置入雷帕霉素药物洗脱支架的患者156例,分为冠心病合并糖尿病组(DM组,78例)和冠心病非糖尿病组(非DM组,78例)。比较2组患者的临床情况和主要不良心脑血管事件(MACCE)的发生情况,并在PCI术后12个月后复查冠状动脉造影。检测术前和术后1、6及12个月的外周血妊娠相关血浆蛋白A(PAPP-A)、基质金属蛋白酶9(MMP-9)和基质金属蛋白酶组织抑制因子1(TIMP-1)水平。结果共150例完成随访(96.2%),DM组有8例(10.8%)患者发生MACCE,非DM组有6例(7.9%)发生MACCE,DM组比非DM组患者MACCE发生率高(P<0.05)。DM组患者术后及随访时管腔直径狭窄率、晚期管腔丢失指数均高于非DM组(P<0.05)。术前及术后DM组患者MMP-9、TIMP-1及PAPP-A水平均高于非DM组(P>0.05)。结论冠心病合并DM患者置入雷帕霉素药物洗脱支架术后远期MACCE发生率增高,再狭窄率同非DM患者相似。PCI术后6个月斑块稳定性较差。

Objective To investigate the long-term outcomes and the activity of risk biomarkers after sirolimus-eluting stent implantation for patients with diabetes mellitus.Methods Totally 156 consecutive patients receiving sirolimus-eluting stent implantation for the first time were studied.The patients were divided into DM group（patients with diabetes mellitus,n =78）and non DM group （patients without diabetes mellitus,n =78）.All the patients were followed up for 1 year.The major adverse cardiac cerebral vessels events （MACCE）rate were observed.All the patients underwent quantitative coronary angiography at 12 months after percutaneous coronary intervention（PCI）.The activity of matrix metalloproteinase-9（MMP-9）,tissue inhibitor of metalloproteinases-1（TIMP-1）,and pregnancy associated plasma protein A （PAPP-A）in all patients were examined before and 1,6,12 months after PCI.Results A total of 150（96.2%）patients（74 in DM group and 76 in non DM group）accomplished follow-up.A trend toward higher MACCE rate was observed in diabetic patient（s8/74,10.8%）compared to non-diabetic patients （6/76,7.9%）（P 〈 0.05）.The late loss index and percentage of diameter stenosis in DM group were higher than non DM group（P 〈 0.05）.The levels of MMP-9,TIMP-1 and PAPP-A before and after PCI in DM patients were higher than those of the non DM patients （P 〈 0.05）.Conclusion After sirolimus-eluting stent implantation,there are a higher risk of MACCE and a similar risk of restenosis in the patients with and without diabetes mellitus.The plaque rupture process trends to occur at six months after sirolimus-eluting implantation.