冠心病患者血小板活化因子在药物洗脱支架置入前后的变化及意义

Change of level of platelet activating factor after drug eluting stent implantation in patients with stable coronary heart disease and its significance

目的：比较稳定型冠心病患者动脉血浆血小板活化因子（PAF）浓度在药物洗脱支架（DES）置入前、后的变化,探讨基线PAF水平与心血管事件的关系。方法：2007年8月至2008年12月,入选88例稳定冠心病患者,收集其临床、冠脉造影（CAG）和经皮冠脉介入治疗（PCI）资料。所有入选者均采用酶联免疫吸附法测定PCI前留取的动脉（主动脉根部）血浆PAF水平。根据基线PAF水平分层,随访1年时的死亡、非致死性急性冠脉综合征（ACS）、再次PCI、再次心血管原因入院等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CAG复查和PAF水平测定。结果：DES置入8个月后随访PAF浓度明显低于基线水平[（236.25±17.78）pg/ml∶（349.92±38.44）pg/ml,P=0.0109]。平均随访12.5月,PAF高水平（PAF≥260pg/ml）组死亡、非致死性ACS、再入院和再次PCI联合终点心血管事件较低水平（PAF〈260pg/ml）组明显增多（RR=1.714,95%CI：1.051~2.796,P=0.031）。结论：稳定冠心病患者血小板活化因子水平与短期内主要不良心血管事件有关;药物洗脱支架置入8个月后血小板活化因子水平明显降低,可能与其有效地抑制了炎症反应和降低了血小板的激活有关。

Objective： To compare plasma levels of platelet activating factor（PAF） before and after drug eluting stent（DES） implantation in patients with stable coronary heart disease（CHD）,and explore the association between baseline PAF level and cardiovascular events.Methods： A total of 88 cases with stable CHD were enrolled from August 2007 to December 2008.Data of clinical characteristics,coronary angiography（CAG） and percutaneous coronary intervention（PCI） were collected in these patients.Enzyme linked immunosorbent assay was used to measure plasma level of PAF（aortic root） in all patients before PCI.According to stratification of baseline PAF level,patients were followed up to one year after PCI for main cardiovascular events.After DES implantation for a mean eight months,29 patients with stable CHD were measured for CAG and PAF again.Results： After DES implantation eight months,PAF concentration was significantly lower than baseline level [（236.25±17.78）pg/ml vs.（349.92±38.44）pg/ml,P=0.0109].After follow up to mean 12.5 months,combine end-point of cardiovascular events（death,nonfatal ACS,repeated PCI and rehospitalization）significantly increased in high PAF level（PAF≥260pg/ml）group compared with that in low PAF level（PAF260pg/ml）group（RR=1.714,95%CI：1.051~2.796,P=0.031）.Conclusion： PAF level in patients with stable CHD is related with short-term main cardiovascular events.After DES implantation eight months,PAF level significantly decreases which might be attributed to inhibition of inflammatory reaction and activation of platelet.