血管内支架表面生物涂层材料与血管内再狭窄

Biological coating materials of intravascular stent surface and intravascular restenosis

背景:心脏病是威胁人类健康的首要病因之一,现在全世界每年大约有1500万例冠心病患者需要接受经皮穿刺冠状动脉(冠脉)成形治疗,但是大约10%发生急性或亚急性冠脉阻塞,6个月后再狭窄发生率高达20%～50%,再狭窄已成为制约经皮穿刺冠状动脉(冠脉)成形术发展的最主要因素。目的:探讨药物洗脱支架治疗支架内再狭窄的长期临床效果。方法:作者以"药物洗脱支架,阻塞,再狭窄"为检索词,在中国期刊全文数据库中,采用电子检索的方式进行文献检索。排除Meta分析及重复性研究,共检索到25篇文献,从支架置入治疗进展,不同材料及类型支架对开通率、开通时间的影响,以及预防支架狭窄等方面进行探讨。结果与结论:药物洗脱支架运用先进的支架载药及药物控制释放技术,在支架机械支撑病变血管的同时,具有抑制血管平滑肌细胞增生的药物从支架表面缓慢释放,作用于与支架接触的血管壁,解决了血管弹性回缩、重塑以及内膜的过度增生问题。随着冠状动脉介入治疗设备的改进和创新,药物涂层支架技术也在不断地成熟和发展。目前新出现的药物涂层支架设计理念是建立在药物筛选和可控释放系统基础上的。相信未来的药物涂层支架将能够应用于更多的血管复杂病变(尤其是静脉和多血管损伤)以及其他脏器疾病。

BACKGROUND：Cardiopathy is one of the most important causes of disease which threaten human health.Every year,about 15 million patients with coronary heart disease around the world need percutaneous puncture coronary angioplasty therapy.But about 10% of them develop acute and subacute artery occlusion;20% to 50% of them develop intravascular restenosis in six months.Restenosis has already become one of the most critical factors that restrict the development of percutaneous puncture coronary angioplasty.OBJECTIVE：To discuss the long-term clinical effects of drug-eluting stent in stent restenosis.METHODS：An online search of Chinese Journal Full-text Database was performed for articles with the keywords of ＂drug-eluting stent＂,＂obstruction＂ and ＂restenosis＂.Meta analysis and repetitive studies were excluded.A total of 25 articles were retained,involving the progress of stent placement,the prevention of stent stenosis and the effects of different stent types,materials on recanalizing rate and recanalizing time.RESULTS AND CONCLUSION：Using drug-loading technology and controlled drug release technology,the drug-eluting stent mechanically support the lesion vessels;in the mean time,drugs that inhibit the proliferation of vascular smooth muscle cells release slowly from the stent surface,act on the vascular walls touching the stent.Thereby,problems of elastic recoil and intima hyperplasia are solved.With the improvement and innovation of interventional equipments for coronary,drug-eluting stent technology is maturing and developing.The design concept of the emerging drug-eluting stent technology is based on drug screening and controlled drug release system.It is believed that drug-eluting stents will be used in a wide range of complex vascular lesions（especially venous diseases and vascular injuries） and other organ diseases.