雷帕霉素洗脱支架对冠心病患者血管内皮功能及炎症因子水平的影响

Effects of rapamycin eluting stents on vascular endothelial function and levels of inflammatory cytokines in patients with coronary heart disease

目的探讨雷帕霉素洗脱支架对冠心病患者血管内皮功能及炎症因子水平的影响。方法选取2019年5月至2023年3月在临海市第二人民医院实施经皮冠状动脉介入治疗(PCI)术的200例冠心病为研究对象,其中术中置入雷帕霉素洗脱支架(观察组)100例,置入钴基支架(对照组)100例。观察并比较两组患者手术成功率、术后并发症发生率,以及支架置入前(T_(1))、支架置入后30 min(T_(2))、支架置入结束即刻(T_(3))、支架置入后3个月(T_(4))、支架置入后6个月(T_(5))血流动力学参数(包括平均动脉压、心率)、血浆内皮素1水平和血清炎症因子(包括C反应蛋白、白细胞介素6)水平。结果观察组手术成功率明显高于对照组(97.0%比89.0%,P=0.027)。两组患者支架置入前后不同时点各项血流动力学参数、血浆内皮素1水平和血清炎症因子水平比较,差异均有统计学意义(均P<0.01);观察组T_(2)、T_(3)、T_(4)、T_(5)时内皮素1、C反应蛋白、白细胞介素6水平均明显低于对照组(均P<0.01)。观察组术后并发症总发生率明显低于对照组(7.0%比18.0%,P=0.019)。结论雷帕霉素洗脱支架对冠心病患者血管内皮功能及炎症因子水平均有一定的影响,但较钴基支架的影响小且安全性高。

Objective To investigate the effects of rapamycin eluting stents on vascular endothelial function and inflammatory cytokines in patients with coronary heart disease(CHD).Methods Two hundred CHD patients underwent percutaneous coronary intervention(PCI)in Linhai Second People's Hospital from May 2019 to March 2023 were included.Among them,100 cases were implanted with rapamycin eluting stents(observation group)and 100 cases were implanted with cobalt-based stents(control group).The hemodynamic parameters(including mean arterial pressure and heart rate),plasma endothelin-1 and serum inflammatory factors(including C-reactive protein and interleukin-6)were measured before stent implantation(T_(1)),at 30 min after stent implantation(T_(2)),immediately after stent implantation(T_(3)),in 3 months after stent implantation(T_(4)),and 6 months after stent implantation(T_(5))were observed and compared between the two groups.Results The success rate of PCI was significantly higher in the observation group than in the control group(97.0%vs.89.0%,P=0.027).There were significant differences in hemodynamic parameters,plasma endothelin-1 levels and serum inflammatory factors at different time points before and after stent implantation between the two groups(all P<0.01).The levels of endothelin 1,C-reactive protein and interleukin 6 at T_(2),T_(3),T_(4) and T_(5) in observation group were significantly lower than those in control group(all P<0.01).The total incidence of postoperative complications in the observation group was significantly lower than that in the control group(7.0%vs.18.0%,P=0.019).Conclusion Rapamycin eluting stent has certain effects on vascular endothelial function and inflammatory cytokines in CHD patients,but less effective and higher safety than that of cobalt-based stents.