冠心病患者常规支架术和直接支架术后血清淀粉样物质A的动态变化及意义

Serum amyloid A in patients with ischemic heart disease accepted direct or conventional stenting

目的 :观察支架术后血清淀粉样物质A(SAA)的动态变化 ,比较常规支架术和直接支架术后SAA变化的差异及意义。方法 :选择常规支架术和直接支架术的患者各 4 0例 ,在支架置入前 ,置入后即刻、2 4h、4 8h ,出院前的不同时间段采血测SAA ,比较两组间的差异 ,所有患者随访 6个月 ,观察主要不良心血管事件的发生情况。结果 :常规支架组和直接支架组在支架置入前SAA略高于正常 ,但两组间差异无显著性意义 ,支架置入后即刻开始升高 ,2 4h升高明显 ,4 8h左右达峰值 ,以后缓慢下降 ,出院时仍维持较高水平 ,并且在 2 4、4 8h和出院时两组间差异显著 (P <0 .0 5 ,<0 .0 1,<0 .0 1)。常规支架组总的不良心血管事件发生率为 2 5 .0 % ,直接支架组总的不良事件发生率 7.5 % ,两组间比较差异有显著性意义 (P <0 .0 5 ) ,并且不良事件发生率的高低与出院时的SAA高低相一致。结论 :常规支架术由于反复的球囊预扩张 ,内膜损伤重 ,术后炎症反应剧烈 ,其远期并发症明显多于直接支架术。对一些合适病变 ,可以首选直接支架术。

Objective:To observe the dynamic changing of serum amyloid A(SAA) after stenting and find out the differences between conventional stenting and direct stenting. To explore the different prognostic meanings between 2 groups.Methods:We selected 40 conventional stenting patients and 40 direct stenting patients, and collected their blood samples before stenting, immediately, 24 h and 48 h after stenting and before distharged from hospital. The blood levels of SAA were detected with ELISA. All patients were followed up for 6 months, to observe the main events such as unstable angina, acute myocardial infarction, revasculation and cardiac death.Results:Before stenting, the levels of SAA were higher in 2 groups than that in normal, but the differences were not significant. The level of SAA began to rise shortly after stenting and was apparently higher at 24 h, reached the peak level at 48 h, and then decreased slowly and maintained a high level when discharged from hospital. At the momments of 24 h, 48 h, and when discharged from hospital, the differences of SAA in 2 groups were significant (P< 0.05 , P< 0.01 , P< 0.01 ). After followed up for 6 months, the incidence of total cardiac event was 25% in conventional stenting group and 7.5 % in direct stenting group, the difference was also siganificant (P< 0.05 ). More importantly, the incidence of total cardiac event was corresponding to the the level of SAA when discharged from hospital.Conclusion:Because of repeated dilation with balloon, the damage to intima is more serious in conventional stenting group, and the inflammation is move dromatie too, so the long term complications of conventional stenting present much more than those in direct stenting, therefore to some appropriate lesions, we can select direct stenting at first.