川芎嗪预防下肢动脉硬化闭塞症介入术后再狭窄的机制研究

Study of the mechanism of Tetramethylpyrazine mediated prevention of in-stent restenosis after intervention of arteriosclerotic obliterans

目的探讨川芎嗪预防下肢动脉硬化闭塞症(ASO)介入术后支架内再狭窄(ISR)的机制。方法对2013年7月至2015年6月本院收治的120例ASO患者进行经皮腔内血管成形术(PTA)结合支架植入术,患者随机分为对照组(口服阿司匹林100 mg/d+波立维75 mg/d,持续6个月)和川芎嗪组(口服阿司匹林100 mg/d+波立维75 mg/d+盐酸川芎嗪片300 mg/d,持续6个月),每组各60例。比较两组患者术后7天的血小板衍生生长因子-BB(PDGF-BB)水平及术后1年的ISR发生率。结果对照组和川芎嗪组术后7天PDGF-BB水平均较术前升高(P<0.05),且两组术后7天PDGF-BB水平比较差异有统计学意义(1479.73±118.08 vs 1430.92±114.17,P=0.023)。对照组和川芎嗪组术后1年ISR发生率比较差异有统计学意义(29%vs 14%,P=0.048),两组ISR患者术后7天的PDGF-BB水平均高于无ISR患者(均P<0.05)。结论川芎嗪可降低ASO介入术后ISR发生率,其降低ISR发生率的机制可能与抑制血浆中PDGF-BB表达有关。

Objective To explore the mechanism of tetramethylpyrazine mediated prevention of in-stent restenosis （ISR） after the intervention of arteriosclerotic obliterans. Methods One hundred and twenty patients with arteriosclerotic obliterans from Jul.2013 to Jun. 2015 in our centre were randomly divided into control group [aspirin （100 mg/d）＋ Plavix （75 mg/d） for 6 months,n.=60]and tetramethylpyrazine group [aspirin （100 mg/d）＋ Plavix （75 mg/d） ＋ tetramethylpyrazine （300 mg/d ） for 6 months, n = 6 0 ] , and average PDGF-BB 7 days after surgery and ISR at one year was compared among groups. Results The average PDGF-BB 7 days after surgery was （1479.73±118.08） ng/L and （1430.92±114.17） ng/L for the control group and tetramethylpyrazine group, respectively（P=0.023） .At 12 months follow-up, the ISR rates were 29% and 14% for the control group and tetramethylpyrazine group, respectively（P=0.048）. Compared with the average preoperative PDGF-BB, the average postoperative PDGF-BB was significantly increased in both the control group and tetramethylpyrazine group, respectively （P〈0.05）. The average postoperative PDGF-BB of restenosis patients was higher than those of non -restenosis patients in both groups, respectively. Conclusion Tetramethylpyrazine could reduce the incidence of ISR, which might be related to inhibiting the expression of PDGF-BB in plasma.