冠心病糖尿病患者冠脉介入治疗前后血栓形成前状态分子标志物变化及其意义(摘要)

The changes and siginificances of molecular markers of prethrombotic state in coronary artery disease patients with diabetes mellitus undergoing coronary angioplasty

目的 观察冠心病 (CAD)合并糖尿病 (DM)患者直接经皮冠状动脉腔内成形术 (PTCA)及支架植入术(stenting)前后血栓形成前状态 (TPS)分子标志物的变化并探讨其产生机制。方法 选择CAD(A组 ,12例 )或CAD合并非胰岛素依赖性糖尿病 (NIDDM) (B组 ,2 4例 )患者冠脉造影后进行PTCA及支架置入术 ,分别在术前、术后2 0min、术后 2 4hr、术后 7d采血测定TPS分子标志物、脂质过氧化物 (LPO)、及内皮功能等指标 ,并动态随访介入治疗后冠脉病变再狭窄情况。结果 两组患者术后PTS分子标志物、LPO、及内皮功能等指标均有明显变化 ,但B组变化更趋明显 ,至术后第 7d ,A组基本恢复至术前水平 ,但B组仍存在明显变化。追踪随访半年发现A组有 1例患者发生再狭窄 ,B组有 2例患者发生再狭窄。结论 CAD患者介入治疗后出现TPS分子标志物及脂质过氧化损伤以及内皮功能等一系列变化 。

Objective To observe the changes and investigate the mechanisms of molecular markers of prethrombotic state in coronary artery disease (CAD) patients with diabetes mellitus (DM) undergoing percutaneous transluminal coronary angioplasty(PTCA) and stent implatation(stenting).Methods 12 patients with CAD(group A) and 24 CAD patients with non- insulin dependent diabetes mellitus (NIDDM)(group B) were studied by undergoing PTCA and stenting, and molecular markers of prethrombotic state, lipid peroxide, endothelial function were respectively measured before and after 20 minutes, 1day, 7days of the operation, and the follow up restenosis of the coronary arteries was carried out after the operation. Results Comparion with the operation before, there were significant changes of molecular markers of prethrombtic state, lipid peroxide, and endothelial function in both groups after the operation, but the changes were even more pronounced in group B. It was the 7th day that there were still the changes in group B, whereas the changes were prone to the levels of pre-operation in group A. During the following up a half years, only 1 patient presented the coronary arteries restenosis in group A, whereas 2 patients presented the coronary arteries restenosis in group B. Conclusions There were a series of significant changes of molecular markers of prethrombotic state, lipid peroxide, and endothelial function in CAD patients after the operation. The changes were even more pronounced in those with DM.