不同药物洗脱支架置入老年急性非ST段抬高型冠脉综合征后的炎症因子反应

Effects of different drug eluting stents on inflammatory factors in elderly patients with non-ST-segment elevation acute coronary syndrome

背景:雷帕霉素及其衍生物依维莫司洗脱支架能改善急性冠脉综合征患者支架置入后的炎症反应,减少再狭窄的发生率。Firebird支架是目前中国使用最广泛的国产雷帕霉素药物洗脱支架,XIENCE.V支架是目前使用最多的雷帕霉素衍生物依维莫司洗脱支架。目的:比较国产雷帕霉素洗脱Firebird支架及进口XIENCE.V支架对老年非ST段抬高型急性冠脉综合征患者经皮冠状动脉介入后炎症因子高敏C-反应蛋白及白细胞介素6影响的差异。方法:选取2012年9月至2014年7月间老年非ST段抬高型急性冠脉综合征患者112例,其中不稳定心绞痛47例,非ST段抬高型心肌梗死65例。经药物治疗病情72 h后,行经皮冠状动脉介入治疗,其中Firebird支架组58例,XIENCE.V支架组54例。结果与结论:与置入前相比,两组高敏C-反应蛋白及白细胞介素6置入后24 h显著升高(P<0.01),置入后1个月显著下降(P<0.05)。置入后24 h、1周、1个月,两组高敏C-反应蛋白及白细胞介素6差异无显著性意义。两组术中及置入后1个月均无心脏意外事件发生,两组安全性及组织相容性相似。结果证实,Firebird支架与XIENCE.V支架治疗均能抑制老年非ST段抬高型急性冠脉综合征患者支架置入后炎症反应,且临床疗效相似。

BACKGROUND： Rapamycin eluting stent and its derivative-the everolimus eluting stent can improve the general inflammatory reaction after stent implantation in patients with acute coronary syndrome, and reduce the incidence of restenosis. Firebird stent as a domestic rapamycin eluting stent is currently the most widely used in China, while XIENCE.V stent as an everolimus eluting stent is the most widely used OBJECTIVE： To compare the effects of domestic Firebird stent and imported XIENCE.V stent on serum high-sensitivity C-reactive protein and interleukin-6 levels after stent implantation in elderly patients with non-ST segment elevation acute coronary syndrome. METHODS： Totally 112 elderly patients with non-st segment elevation acute coronary syndrome, including 65 cases of acute non-ST segment elevation myocardial infarction and 47 cases of unstable angina pectoris, were enrolled from September 2012 to July 2014. After 72 hours medical treatment, the patients were subject to percutaneous coronary intervention and divided into two groups： Firebird stent group and XIENCE.V stent group. RESULTS AND CONCLUSION： There was no difference in the levels of serum high-sensitivity C-reactive protein and interleukin-6 between the two groups after stent implantation. The serum high-sensitivity C-reactive protein and interleukin-6 levels at 24 hours after stenting were significantly increased in each group compared with the baseline （P 〈 0.01）, while the levels of high-sensitivity C-reactive protein and interleukin-6 were declined significantly after 1 month of stent implantation （P 〈 0.05）. However, there was no difference in the levels of serum high-sensitivity C-reactive protein and interleukin-6 between the two groups at 24 hours, 1 week, and 1 month after stent implantation. No cardiac accidents occurred in the two groups during and 1 month after percutaneous coronary intervention and stent implantation. Two groups had similar security and histocompatibility. The results confirm that both of Firebird stent and XIENCE.V stent can inhibit inflammatory responses and have similar clinical efficacy in elderly patients with non-ST segment elevation acute coronary syndrome.