颅内动脉狭窄支架成形术后血管再狭窄危险因素研究

The risk factors of restenosis after intracranial arterial stenosis stent angioplasty

目的观察颅内动脉狭窄患者血管内支架成形术前后凝血功能、活化血小板以及C反应蛋白与血管再狭窄的关系。方法随机选择本院20例接受血管内支架成形术的颅内动脉狭窄患者,于术前、术后3 d及术后12个月检查凝血功能、活化血小板以及C反应蛋白水平,并对术后血管再狭窄及无再狭窄患者的凝血功能、活化血小板以及C反应蛋白水平进行比较。选择同期20例健康体检者作为对照组。采用免疫散射比浊法测定血清CRP含量;血浆凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)用凝固法;血小板活化指标中P选择素(CD62p)、糖蛋白(GP)Ⅱb/Ⅲa受体复合物用流式细胞仪测定。结果颅内动脉狭窄患者血管内支架成形术后3 d及术后12个月的血清凝血功能指标、活化血小板以及C反应蛋白水平均明显高于术前(P均<0.05)。再狭窄组术后12个月时凝血功能、活化血小板及C反应蛋白水平明显高于无狭窄组(P<0.05)。结论颅内动脉狭窄患者行血管内支架成形术可导致血浆凝血功能激活,活化血小板以及C反应蛋白水平增高,而且上述指标随访期间高表达是支架术后再狭窄的危险因素。

Objective To investigate the relationship between clotting, platelet activation, C-reactive protein before and after intraeranial arterial stenosis stent angioplasty and vascular restenosis. Methods Twenty patients with intraeranial arterial stenosis were selected and given stent angioplasty. Before angioplasty, 3 d and 12 months after angioplasty,the clotting, platelet activation, C-reactive protein were detected, and these indexes were compared between patients with and without restenosis. 20 eases of healthy people in the same period were selected as control group. Serum CRP levels were detected by immune scattering nephelometry, prothrombin time （PT）, thrombin time （Tr）, activated partial thromboplastin time （AFVF） were detected by coagulation; Platelet activation markers sunch as P-selectin （CD62p）, glycopro- tein （GP） Ⅱ b / Ⅲ a receptor complex were determined by flow eytometry. Results In 3 d and 6 to 12 months after angioplasty, serum coagulation function, platelet activation and C-reactive protein levels were significantly higher than that before surgery （P all 〈0. 05）. The serum coagulation function, platelet activation and C-reactive protein levels of restenosis group were significantly higher than no-restenosis group （P〈0.05）. Conclusion In patients with intracranial arterial stenosis, the stent procedures can lead the ctivation of serum coagulation function and increase platelet, C-reactive protein level. So high expression of these index are the risk factors of stent restenosis.