国产雷帕霉素药物洗脱支架和紫杉醇药物洗脱球囊对冠心病患者近期预后的影响

Effect of Domestic Rapamycin Drug-Eluting Stents and Paclitaxel Drug-Eluting Balloons on the Recent Prognosis in Patients with Coronary Heart Disease

目的探究国产雷帕霉素药物洗脱支架与紫杉醇药物洗脱球囊对冠心病患者经皮冠状动脉介入术(PCI)近期预后的影响。方法研究对象为2020年3月至2021年3月在新乡医学院第一附属医院接受介入治疗的冠心病患者,回顾性选取56例接受国产雷帕霉素药物洗脱支架置入的患者作为药物洗脱支架组,另选取57例接受紫杉醇药物洗脱球囊扩张的患者作为药物球囊洗脱组,均进行1 a随访,对术前术后1周时的心率变异性指标、冠状动脉造影结果参数、靶病变管腔直径及狭窄情况及血清激肽释放酶1(KLK1)、基质金属蛋白酶组织抑制因子-1(TIMP-1)、内皮素-1(ET-1)、一氧化氮(NO)水平进行比较,并比较术后1 a内发生不良心血管事件情况。结果两组术前和术后1周的正常窦性RR间期标准差(SDNN)、均值标准差(SDANN)、相邻NN间期之间差大于50 ms数占比(pNN50)、靶病变参考血管直径、最小管腔直径、直径狭窄率组间差异无统计学意义(P>0.05),术后1周两组SDNN、SDANN、pNN50、靶病变最小管腔直径指标均较术前升高(P<0.05),直径狭窄率较术前降低(P<0.05),靶病变参考血管直径较术前无变化(P>0.05)。术前,两组患者的KLK1、TIMP-1、ET-1、NO水平差异无统计学意义(P>0.05),术后1周两组KLK1、NO水平较术前升高且研究组更高,TIMP-1、ET-1水平较术前降低且研究组更低(P<0.05)。两组随访期内不良心血管事件发生率差异无统计学意义(P>0.05)。结论在对冠心病患者进行PCI治疗时,使用国产雷帕霉素药物洗脱支架与紫杉醇药物洗脱球囊近期预后方面的效果相似,且不会增加患者预后不良风险。

Objective To explore the impact of domestic rapamycin drug-eluting stent and paclitaxel drug-eluting balloon on the recent prognosis of percutaneous coronary intervention(PCI)in patients with coronary heart disease.Methods The study included coronary heart disease patients treated with interventional procedures at the First Affiliated Hospital of Xinxiang Medical University from March 2020 to March 2021.Fifty-six patients who received domestic rapamycin drug-eluting stents were retrospectively selected as the drug-eluting stent group,while fifty-seven patients who underwent paclitaxel drug-eluting balloon angioplasty were chosen as the drug-eluting balloon group.Both groups were followed up for one year.Preoperative and one-week postoperative indicators of heart rate variability,coronary angiography parameters,target lesion luminal diameter,and narrowing,as well as serum levels of kallikrein-1(KLK1),tissue inhibitor of metalloproteinases-1(TIMP-1),endothelin-1(ET-1),and nitric oxide(NO)were compared.The incidence of adverse cardiovascular events within one year after the procedure was compared.Results There were no differences between the two groups in the standard deviation of NN intervals(SDNN),standard deviation of the average of NN intervals(SDANN),percentage of differences between adjacent NN intervals greater than 50 ms(pNN50),reference vessel diameter of target lesion,minimum lumen diameter and diameter stenosis rate before and 1 week after operation(P>0.05).At 1 week after operation,the SDNN,SDANN,pNN50 and minimum lumen diameter of target lesion in the two groups were higher than those before operation(P<0.05),the diameter stenosis rate was significantly lower than that before operation(P<0.05),and the reference vessel diameter of target lesion was unchanged compared with that before operation(P>0.05).Before operation,there were no differences in KLK1,TIMP-1,ET-1 and NO levels between the two groups(P>0.05).At 1 week after operation,KLK1 and NO levels in the two groups were higher than those before operation,and those in the study group were higher than those before operation,and TIMP-1 and ET-1 levels were lower than those before operation,and those in the study group were lower than those before operation(P<0.05).There was no difference in the incidence of adverse cardiovascular events between the two groups during the follow-up period(P>0.05).Conclusion When treating PCI in patients with coronary heart disease,the effect of using domestic rapamycin drug-eluting stent and paclitaxel drug-eluting balloon is similar in recent outcomes and do not increase the risk of poor prognosis.