冠状动脉支架内再狭窄及其危险因素概述

Review of coronary in-stent restenosis and its risk factors

冠状动脉粥样硬化性心脏病(简称冠心病)是严重威胁人类健康的主要疾病之一,针对冠心病最常用的治疗方式是经皮冠状动脉介入术(PCI)。支架植入后发生的支架内再狭窄(ISR)始终是困扰介入医师和患者的并发症。目前认为支架内再狭窄发生可能与血管内膜新生和新生动脉粥样硬化相关,但其具体进展机制尚无定论,因此仍缺乏针对ISR的预防和治疗策略。现有研究发现与ISR相关的危险因素包括病变因素、介入医师的手术因素和患者因素等,其中以冠心病PCI术后患者合并糖尿病、脂代谢异常和高尿酸血症等代谢紊乱状态时,ISR发生风险明显增加,但其早期检测仍存在局限性。近年来,随着技术的发展,代谢组学等新兴技术得到了更广泛的临床应用,未来可能在ISR的早期诊断中发挥更重要的作用。

Coronary heart disease(CHD)is one of the major diseases that seriously threaten human health,and its most commonly used treatment is percutaneous coronary intervention(PCI).However,in-stent restenosis(ISR)after stent implantation is always a complication that confuses doctors and patients.At present the occurrence of ISR is believed to be associated with vascular intimal hyperplasia and neo-atherosclerosis,but its specific progression mechanism is still inconclusive.Therefore,preventive and therapeutic strategies for ISR remain unavailable.Studies have found that risk factors of ISR include lesion-related,interventionist-related and patient-related factors.Among them,ISR is especially associated with metabolic disorders such as diabetes,dyslipidemia and hyperuricemia in patients undergoing PCI after coronary heart disease.The risk of ISR in these patients is significantly increased but its early detection is still limitated.Development of technology and emerging technologies such as metabolomics in recent years have been widely used clinically and may play a more important role in the early diagnosis of ISR in the future.