Nano无载体药物支架对PCI后非罪犯病变进展的抑制作用

Inhibitory effect of Nano carrier-free drug eluting stent on development of non-culprit coronary lesions after PCI

目的探讨Nano无载体药物支架对经皮冠脉介入治疗(PCI)后非罪犯冠状动脉(冠脉)病变(NCCLs)进展的抑制作用及其可能机制。方法入选2015年1月至2018年6月于东南大学医学院附属江阴医院心血管内科行PCI患者106例,依据植入支架类型分为Nano组(n=65)和Firebird2组(n=41)。检测所有患者术后1周和术后1年高敏C反应蛋白(hs-CRP)及白介素-6(IL-6)水平,随访1年后NCCLs进展情况。结果Nano组患者PCI后1年NCCLs进展比例明显低于Firebird2组患者(P=0.016),并且Nano组患者因为NCCLs进展而行PCI的患者比例也明显低于Firebird2组患者(P=0.036)。两组患者术后1周hs-CRP和IL-6水平比较无统计学差异(P>0.05),术后1年随访发现两组患者hs-CRP和IL-6水平均较术后1周明显降低(P<0.05)。术后1年比较,Nano组患者hs-CRP和IL-6水平均低于Firebird2组患者(P<0.05)。术后1年hs-CRP≥4.0 mg/L(P=0.041,OR=4.148)和IL-6≥25 ng/L(P=0.026,OR=4.219)是NCCLs进展的危险因素,植入Nano支架是NCCLs进展的保护因素(P=0.023,OR=0.233)。结论植入Nano支架较Firebird2支架术后1年炎症反应更低,且对NCCLs进展有抑制作用,可能与其无载体特性有关。

Objective To investigate the inhibitory effect of Nano carrier-free drug eluting stent(DES)development of non-culprit coronary(NCCLs)lesions after PCI and possible mechanism.Methods The patients undergone PCI(n=106)were chosen from Department of Cardiovascular Medicine in Jiangyin Hospital affiliated to Medical School of Southeast University from Jan.2015 to June 2018,and divided,according to types of DES,into Nano group(n=65)and Firebird2 group(n=41).The levels of high-sensitive C-reactive protein(hs-CRP)and interleukin-6(IL-6)were detected in 2 groups after PCI for 1 week and 1 y.The development of NCCLs was followed up after 1 y.Results After PCI for 1 y,the percentage of patients with NCCLs development was significantly lower in Nano group than that in Firebird2 group(P=0.016),and percentage of patients received PCI due to NCCLs development was also significantly lower in Nano group than that in Firebird2 group(P=0.036).The levels of hs-CRP and IL-6 had no statistical difference in 2 groups after PCI for 1 week and 1 y(P>0.05),and decreased significantly in 2 groups during 1-y postoperative follow-up(P<0.05).The levels of hs-CRP and IL-6 were lower in Nano group than those in Firebird2 group after PCI for 1 y(P<0.05).After PCI for 1 y,hs-CRP≥4.0 mg/L(P=0.041,OR=4.148)and level of IL-6≥25 ng/L(P=0.026,OR=4.219)were risk factors of NCCLs development,and implantation of Nano carrier-free DES was a protective factor of NCCLs development(P=0.023,OR=0.233).Conclusion The inflammatory reaction is less after implantation of Nano carrier-free DES compared with Firebird2 stenting after 1 y,and NCCLs development is inhibited,which may be related to carrier-free.