冠状动脉内^(192)Ir射线对糖尿病患者支架内再狭窄复发治疗作用的血管内超声分析

The mechanism of intracoronary ^( 192) Ir radiotherapy in diabetes with in-stent restenosis analyzed by intravascular ultrasound

目的 用血管内超声 (IVUS)分析冠状动脉 (冠脉 )内192 Ir射线治疗对糖尿病患者支架内再狭窄 (ISR)复发的作用机制及疗效。 方法 6 7例患者分为放疗组和对照组 ,在放疗后即刻和 6个月后行冠脉造影和IVUS检查 ,术后随访 1年。 结果 两组术后 6个月支架内的最小管腔内径、面积和平均面积均减少 ,分别为 (- 0 2 16± 0 35 4 )与 (- 0 6 79± 0 4 6 7)mm、(- 0 70 8± 1 332 )与 (- 2 4 82± 1 5 4 2 )mm2 、(- 0 5 4 6± 1 36 6 )与 (- 2 0 2 0± 2 0 4 8)mm2 ,均为P <0 0 1,对照组较放疗组的减少更为明显 ;两组治疗后的平均新生内膜面积和新生内膜百分比均增加 ,分别为 (0 5 93± 0 94 1)与 (2 10 2±1 74 1)mm2 、(10 4 8± 18 4 6 )与 (38 2 9± 36 76 ) ,均为P <0 0 0 1,对照组较放疗组的增加更为明显 ;冠脉造影显示 ,放疗组的再狭窄复发率低于对照组 (47 2 %与 84 2 % ,P <0 0 1)。术后 1年 ,靶血管再成形术及靶病变再成形术的发生率放疗组也低于对照组 (2 5 6 %与 5 6 5 % ,11 1%与 37 5 % ,P <0 0 5 )。 结论 IVUS分析证实 ,冠脉内192 Ir射线可抑制支架内的新生内膜形成 ,减少糖尿病患者ISR的复发 ,并且降低 1年靶血管及靶病变再次成形术的发生率。

Objective Using intravascular ultrasound (IVUS), studying the mechanisms and one year clinical follow up eflects of intracoronary 192 Ir radiotherapy in diabetes with in stent restenosis(ISR). Methods Sixty seven patients were first treated with conventional techniques and then randomly (blinded) to receive either gamma radiation ( 192 Ir) or a placebo. IVUS was carried out immediately after the irradiation and followed up for 6 month. Serial stent, lumen and intimal hyperplasia(IH) (stent lumen) were measured at every 1 mm within the stent. postoperational follow up persisted for one year. Results Baseline clinical, vessel location and conventional techniques were similar in both groups. Minimal stent area and mean stent area were similar at postirradiation and followed up in both groups. However, the decrease in differences of minimal lumen area and the increase in differences of mean IH area and IH% was less in 192 Ir patients compared with placebo patients. Binary angiographic restenosis was less in the 192 Ir patients compared with the placebo patients (47 2% vs 84 2%, P <0 01). At one year follow up, MACE, TVR and TLR were lower in 192 Ir group compared with the placebo group, 32 6% vs 56 5%, 25 6% vs 56 5%, and 11 1% vs 37 5%, respectively. Conclusions By inhibiting the intimal hyperplasia within the stent, intracoronary 192 Ir radiation is effective in reducing the recurrence of ISR and decreased TVR and TLR rates in diabetes at one year.