巨细胞病毒感染与冠状动脉支架内新生内膜组织量的关系

Relationship between cytomegalovirus infection and neointimal proliferation within stent after coronary angioplasty

目的 探讨巨细胞病毒 (CMV)感染对冠状动脉支架内内膜增生的影响。方法 180例冠心病患者 ,于冠状动脉内支架置入术后 6个月复查冠状动脉造影和血管内超声检查。定量冠状动脉造影测定随访时的腔径减小 ,血管内超声测定支架内的平均新生内膜组织面积及其与支架横截面积之比。酶联免疫吸附法测定抗人CMVIgG抗体。 结果 CMV感染率达 5 1%。平均血管参考直径为 (2 94± 0 4 8)mm ,支架置入使平均最小腔内直径由 (0 99± 0 35 )mm上升至 (2 4 5± 0 4 2 )mm。 6个月随访时平均腔径减小 (0 74± 0 5 0 )mm ;平均新生内膜组织面积为 (3 8± 1 7)mm2 ,其与平均支架横截面积之比为 (4 5± 18) %。逐步多变量回归分析显示上述再狭窄指标与CMV感染无关联。结论 既往CMV感染与冠状动脉支架内新生内膜组织量无关。

Objective To explore the impact of prior cytomegalovirus (CMV) infection on the neointimal proliferation within stent after coronary angioplasty. Methods One hundred and eighty patients with coronary artery disease were examined by angiography and intravascular ultrasound (IVUS) 6 months after stent implantation. Quantitative coronary angiography was used to assess the late lumen loss. IVUS analysis was performed by a computer assisted system from images recorded during a motorized pullback. The mean cross sectional area of neointimal tissue within the stent and the ratio of this area to the mean stent cross sectional area were assessed every 0.2 mm along the stent and the average value was recorded. Prior CMV infection was identified by anti-CMV IgG determination with an ELISA kit. Results Previous CMV infection was detected in 51% of the population. Average reference diameter was 2.94±0.48 mm and stent implantation increased the average minimal lumen diameter from 0.99±0.35 mm to 2.45±0.42 mm. At 6 months, the average lumen diameter loss was 0.74±0.50 mm, the mean neointimal tissue area was 3.8±1.7 mm 2 and the average ratio of neointimal tissue area over stent area was (45±18) %. None of these variables indicating restenosis was linked with CMV infection. Multivariate analysis showed that the lesion length was the best-correlated variable with the neointimal proliferation within the stent. Conclusion The study shows that prior infection with CMV was not a contributing factor in the process of neointimal proliferation within stent.