经皮冠状动脉介入治疗对冠状动脉微循环的影响

Influence of percutaneous coronary intervention on coronary microcirculation

目的分析经皮冠状动脉介人治疗（pci)对冠状动脉微循环的影响。方法回顾性分析2013年1月~2014年12月湖南湘潭中心医院心血管科CCU收治的130例冠状动脉粥样硬化性心脏病（冠心病）患者临床资料，其中男性67例，女性63例，年龄47~70岁。患者均予以经皮冠状动脉介人治疗，包括经皮冠状动脉腔内成形术（PTCA)、支架置人，对比患者手术前后冠状动脉微循环阻力指数（IMR)与高敏C反应蛋白（hs-CRP)变化。结果术前所有患者IMR水平为（20.41±4.49)U，PTCA后为(27.99±7.05)U，支架置人后为（28.48±4.97)U，支架置人后和PTCA后较术前升高，差异具有统计学意义（P均<0.05)。与术前比较，患者的股动脉、冠状窦hs-CRP水平在PTCA后与支架置人后均明显升高，差异具有统计学意义（P均<0.05)。结论PCI后冠心病患者IMR与hs-CRP水平升高，考虑与手术器械压迫及血管内皮损伤相关，从而导致短期内冠状动脉的微循环障碍。

Objective To analyze the influence of percutaneous coronary intervention(PCI)on coronarymicrocirculation.Methods The clinical materials of130patients(male67,female63and aged from47to70)wereanalyzed in the CCU of Department of Cardiovascular Diseases in Hunan Xiangtan Central Hospital from Jan.2013to Dec.2014.All patients were given PCI,including percutaneous transluminal coronary angioplasty(PTCA)andstenting.The changes of index of microcirculatory resistance(IMR)and high-sensitivity C-reactive protein(hs-CRP)were compared before and after treatment.Results Before the treatment,the level of IMR was(20.41±4.49)U in allp atien ts,an d(27.99±7.05)U afterP T C A an d(28.48±4.97)U aftersten tin g(allP<0.05).T h elev elo fh s-CRP increased significantly in femoral artery and coronary sinus after PTCA and stenting(all P<0.05).ConclusionThe levels of IMR and hs-C R P increase after PCI,which may be related to short-tim e coronary microcirculationdysfunction due to pressure of operative instruments and vascular endothelial injury.