光学相干断层成像评价药物洗脱支架与金属裸支架治疗后的内膜增殖

目的应用光学相干断层成像(OCT)技术比较冠状动脉内雷帕霉素药物洗脱支架(DES)和金属裸支架(BMS)治疗后内膜增殖情况。方法对19例冠心病经冠状动脉内支架置入治疗后5~93个月的患者进行冠状动脉造影复查,造影后对21支血管23个支架进行OCT成像检查。DES术后6~10个月为药物支架A组;BMS术后5~10个月为金属裸支架B组;BMS术后23~93个月为金属裸支架C组。应用OCT成像技术比较3组支架之间内膜增殖情况。结果OCT成像结果显示3组之间有关支架后最大内膜增殖厚度、血管腔直径和截面积丢失及直径和截面积再狭窄等方面差异有统计学意义。其中A组内膜最大增殖厚度明显小于B组(0·20mm±0·13mmvs0·81mm±0·46mm,P=0·019)和C组(0·91mm±0·27mm,P=0·007);A组血管腔直径丢失明显小于B组(0·27mm±0·17mmvs1·12mm±0·79mm,P=0·009)和C组(1·20mm±0·31mmP=0·013);A组直径再狭窄明显小于B组(8%±4%vs36%±24%,P=0·009)和C组(35%±6%,P=0·017);A组截面积丢失明显小于B组(1·14mm2±0·9mm2vs3·96mm2±2·62mm,P=0·009)和C组(4·66mm2±1·66mm2,P=0·006);A组截面积再狭窄明显小于B组(P=0·017)和C组(P=0·009)。置入的13个BMS支架,几乎所有支架支撑杆表面均有内膜覆盖,而置入DES后内膜增殖较少,部分支架支撑杆表面即使在支架术后29个月仍然没有内膜覆盖。结论OCT成像技术可清晰地显示支架支撑杆及表面内膜增殖情况,对评价药物洗脱支架的治疗效果具有重要意义。     

厄贝沙坦抑制兔动脉球囊损伤后再狭窄的作用及机理研究

目的观察国产血管紧张素1型受体拮抗剂厄贝沙坦抑制兔颈动脉球囊损伤后再狭窄(RS)的作用,探讨 RS 可能的机理。方法将48只大耳白兔随机分为实验7、14、28 d 组并各设对照组(每组8只),以球囊损伤左颈总动脉,建立再狭窄模型。术后7、14、28 d 不同时点取材。实验组术前3 d 喂饲厄贝沙坦(35 mg/kg)至处死。病理 HE 染色观察动脉壁内、中膜面积、管腔面积;免疫组化法测定核因子-κB(NF-κB)、核增殖抗原(PCNA)核易位阳性细胞率;实时荧光定量聚合酶链反应(PCR)测定κB抑制蛋白(I-κB)、单核细胞趋化蛋白 mRNA 表达。结果厄贝沙坦实验组与对照组相比,术后7 d 时明显抑制内膜的增生(0.34 mm~2±0.15 mm~2 vs 1.05 mm~2±0.38 mm~2,P<0.05),28 d 时管腔面积明显较大(4.25 mm~2±0.29 mm~2 vs 2.56 mm~2±1.02 mm~2,P<0.05)。术后7 d 时厄贝沙坦明显抑制 NF-κB p65核易位(P<0.05)和 PCNA 的表达(P<0.05)。术后7 d 时厄贝沙坦实验组 I-κB mRNA 含量明显较低(7.2拷贝/μl±0.9拷贝/μl vs 15.6拷贝/μl±0.7拷贝/μl,P<0.05),厄贝沙坦实验组在各时相点均明显抑制 MCP-1 mRNA 的表达(P<0.05)。结论厄贝沙坦通过抑制NF-κB的激活而调控 MCP-1、PCNA 的表达,有效抑制再狭窄的发生发展。     

粒细胞-巨噬细胞集落刺激因子对球囊损伤内膜修复的影响

目的建立兔髂动脉球囊损伤模型,观察粒细胞巨噬细胞集落刺激因子(GM CSF)对损伤内膜修复的影响。方法健康雄性新西兰大白兔24只随机分为GM CSF组和对照组。GM CSF组皮下注射GM CSF10μg·kg1·d1,对照组皮下注射同等量生理盐水。7d后球囊扩张损伤髂动脉。4周后提取损伤动脉标本,观察内皮修复、内膜增生情况并测定病理形态学参数。结果术后4周病理组织学见GM CSF组内膜增生程度明显轻于对照组,新生内膜中血管平滑肌细胞和纤维组织明显少于对照组,内皮较完整、光滑,管腔狭窄程度较轻。形态学参数见GM CSF组的管腔面积明显大于对照组(1.27mm2±0.31mm2vs0.92mm2±0.24mm2),新生内膜面积与内膜增生百分比明显小于对照组(0.85mm2±0.34mm2vs1.18mm2±0.38mm2;40%±7%vs55%±6%)。结论GM CSF能促进损伤内膜修复,减少内膜增生,降低再狭窄率。     

小檗碱对兔颈动脉血管成形术后再狭窄的影响

目的:通过观察小檗碱对球囊损伤后兔颈动脉内膜增生与血管重塑的影响,为血管成形术后再狭窄的防治寻找新的治疗策略。方法:日本大耳白兔40只,随机分为假手术组、模型组、小檗碱组和辛伐他汀组,除假手术组外各组均以球囊导管扩张损伤颈动脉内膜,并分别给予生理盐水、小檗碱和辛伐他汀各2.5 mg/(kg.d)腹腔注射,假手术组仅普食喂养。术后15 d取损伤颈动脉段切片,作形态学观察,利用图像分析系统测量血管新生内膜厚度(IT)、管腔面积(LA)、新生内膜面积(IA)、内弹力板围绕面积(IEL)、中膜面积(MA)、外弹力板围绕面积(EEL)。结果:血管球囊损伤后,小檗碱组和辛伐他汀组IT、IA、IA/MA均显著小于模型组(P<0.01)。与模型组相比,小檗碱组和辛伐他汀组LA、IEL、EEL均显著增大(P<0.01),MA则无显著性差异。结论:小檗碱可通过抑制兔颈动脉新生内膜增生与不良的血管重塑,从而为小檗碱防治血管成形术后再狭窄提供了实验基础。     

Treatment of in-stent coronary restenosis with excimer laser angioplasty

Objective To evaluate the efficacy and safety of excimer laser coronary angioplasty (ELCA) with adjunctive balloon angioplasty in patient with in-stent restenosis.Methods ELCA was performed in 20 patients of in-stent restenosis.All patients were symptomatic and had class Ⅲ-Ⅳ angina. ELCA was performed with the Spectranetics CVX-300 System. The laser catheter of Vittesse C (concentric) and E (eccentric) with diameter of 1.4-2.0 mm was used.Results Laser catheter crossed all stenotic stents without difficulty. The lesion length was 4.6-51.2 mm,mean 20.7±13.7 mm, including 14 lesions &gt;10 mm. Laser treatment alone increased minimal lumen diameter (MLD) from 0.3±0.3 mm to 1.4±0.3 mm (P&lt;0.0001) and improved the diameter stenosis from 88.8%±10.0% to 46.0%±8.0% (P&lt;0.0001). Adjunctive balloon angioplasty further increased minimal lumen diameter to 2.3±0.7 mm and reduced diameter stenosis to 14.2%±8.2% (P&lt;0.0001). At follow-up (1-17 months, mean 8.9±5.7 months), 17 (85%) patients had remained asymptomatic, 3 (15%) patients had mild to moderate exertional angina, 1 (5%) patient received CABG. Conclusion ELCA with adjunctive percutaneous transluminal coronary angioplasty (PTCA) is an efficient and safe technique to debulk tissue in the patient with in-stent restenosis. The incidence of procedural related complication was low and ELCA may be used as a good method for in-stent restenosis treatment.     

Cutting balloon angioplasty for treatment of coronary in-stent restenosis: immediate results and 6-month outcomes

目的　研究切割球囊对支架内再狭窄的即刻和 6个月内随访效果。方法　 6 9例支架内再狭窄患者随机分配到切割球囊和普通球囊治疗组。切割球囊组 38例。球囊扩张前及扩张后即刻在定量冠状动脉造影和冠状动脉内超声下 ,测定相关参数。随访 6个月内临床改善及冠状动脉造影结果。研究终点包括出现心肌梗塞 ,需要冠状动脉搭桥或再介入治疗。结果　两组的手术成功率为 10 0 %。切割球囊组 1例患者扩张后在支架的远端出现夹层。平均随访 6 7± 2 3月。切割球囊组于术后 3和 6个月时的再狭窄率显著低于普通球囊组 (15 %VS 38%及 18%VS 4 3%,P均小于0 0 0 1)。扩张后即刻血管直径获得值在切割球囊组和普通球囊组分别为 1 72± 0 5 2mm和 1 15± 0 5 4mm ,而随访终点时切割球囊组的血管直径晚期丢失为 0 2 6± 0 0 5mm(3个月 )及 0 38± 0 0 6mm ,同时的普通球囊组丢失值为 0 78± 0 19mm(3个月 )及 0 89± 0 16mm。对于支架体部狭窄 ,普通球囊难以固定 ,扩张时移动明显 ,而切割球囊较易于固定 ,扩张时罕见移动。结论　切割球囊治疗支架内再狭窄效果可靠 ,安全 ,容易操作。再狭窄率低 ,手术费用相对易于患者接受 ,是一个较有前途的治疗手段。     

冠状动脉钙化病变对药物洗脱支架植入后内膜增生的作用

目的利用血管内超声观察冠状动脉钙化病变对药物洗脱支架植入后内膜增生的作用。方法对97例(99处病变)冠心病患者在药物洗脱支架植入后8个月利用血管内超声(IVUS)测定支架近端、支架远端和支架内管腔最小处血管段外弹力膜(EEM)横截面积(CSA),支架内CSA,管腔CSA,新生内膜面积,支架最大直径及最小直径,并推算支架对称指数。根据IVUS检测血管钙化的情况将支架植入段血管分为钙化病变组和非钙化病变组,观察钙化病变对支架植入后内膜增生的作用。结果99处病变中有14例支架内内膜增生。与非钙化组患者比较,钙化病变组支架植入后支架两端支架内CSA相似:支架近端为(7·30±1·94)mm2和(6·58±1·96)mm2;支架远端为(6·74±2·02)mm2和(6·14±1·82)mm2。但支架内最小CSA明显减小[(6·10±1·87)mm2和(4·97±1·51)mm2,P<0·05]且对称性较差(对称指数0·92±0·07和0·87±0·09,P<0·05),但内膜面积反而显著减少(0·53±1·50)mm2与(0·02±0·20)mm2。结论冠状动脉药物洗脱支架治疗钙化病变支架扩张程度和对称性均较差,但是与非钙化病变患者比较,内膜增生反而减少。     

A prospective multicenter parallel-controlled trial of TIVOLI biodegradable-polymer-based sirolimus-eluting stent compared to ENDEAVOR zotarolimus-eluting stent for the treatment of coronary artery disease: 8-month angiographic and 2-year clinical follow-up results

Background  Available drug-eluting stents (DES) have achieved great success in reducing restenosis rates. Recently, investigators have demonstrated that the durable polymer carrier plays a significant role in DES-related hypersensitive reaction and delays vessel healing. TIVOLI stent is a novel sirolimus-eluting coronary stent with biodegradable coating containing sirolimus and polylactic-co-glycolic acid (PLGA) polymer. The present study sought to evaluate the effectiveness and safety of the TIVOLI biodegradable-polymer-based sirolimus-eluting stent in treating patients with coronary artery disease. 

Methods  A prospective, multicenter clinical trial comparing TIVOLI biodegradable coated sirolimus-eluting stent with ENDEAVOR zotarolimus-eluting stent was conducted in 324 patients (TIVOLI group: 168 patients; ENDEAVOR group: 156 patients) at 12 centers in China to demonstrate the non-inferiority of in-stent late loss with TIVOLI stent compared to ENDEAVOR stent in subjects with a maximum of two de novo native coronary artery lesions (lesion length ≤40 mm, reference vessel diameter 2.25–4.00 mm). The primary end point was angiographic in-stent late loss at 8-month. The secondary end points were clinical outcomes at 2 years, including major adverse cardiac events (cardiac death, myocardial infarction, or target-lesion revascularization) and stent thrombosis.

Results  Angiographic late lumen loss at 8 months in the TIVOLI group was superior to the ENDEAVOR group (in-stent (0.25±0.33) mm vs. (0.57±0.55) mm, diff (95% CI) –0.23 (–0.32, –0.14), P <0.0001; in-segment (0.25±0.33) mm vs. (0.42±0.55) mm, diff (95% CI) –0.13 (–0.23, –0.02), P=0.0083). The rate of in-stent binary restenosis at 8 months was reduced from 8.6% in the ENDEAVOR group to 2.9% in the TIVOLI group (P=0.0229). Compared to ENDEAVOR stent, TIVOLI stent resulted in a significant reduction in target-lesion revascularization (4.2% vs. 9.6%, P=0.0495) at 2 years. The two-year major adverse cardiac events (MACE) rate was lower for the TIVOLI group, but not significantly different (6.6% vs. 10.9%, P=0.1630).

Conclusions  TIVOLI was superior to ENDEAVOR stent with respect to late lumen loss at 8 months, and it yielded both lower rates of angiographic binary restenosis at 8 months and target lesion revascularization (TLR) at 2 years. The MACE rate at 2 years was comparable in both groups.

     

A prospective randomized antiplatelet trial of cilostazol versus clopidogrel in patients with bare metal stent

Background Cilostazol is a newly developed antiplatelet drug that has been widely applied for clinical use. Its antiplatelet action appears to be mainly related to inhibition of intracellular phosphodiesterase activity. Recently, cilostazol has been used for antiplatelet therapy after coronary bare metal stent implantation for thrombosis and restenosis prevention. This prospective randomized and double blind trial was designed to investigate the safety and efficacy of cilostazol for the prevention of late restenosis and acute or subacute stent thrombosis. Methods One hundred and twenty patients who underwent elective stent were randomly assigned to treatment group with cilostazol 200 mg/d (n = 60), clopidogrel 75 mg/d and aspirin 100 mg/d or to control group with clopidogrel treatment 75 mg/d (n = 60) and aspirin 100 mg/d. Follow-up coronary angiography was performed 6－9 months later.Results Nine months major adverse cardio-cerebral event (MACCE) were lower in treatment groups (P&lt;0.05). The quantitative coronary angiography (QCA) at 6 months follow-up showed that minimum lumen diameter (MLD) was higher in treatment group than that of control group [(2.14±0.52)mm vs (1.82±0.36)mm, P&lt;0.05]. Late lumen loss (LL) [(0.82±0.42)mm vs (1.31±0.58)mm; P&lt;0.01], restenosis rate (RR) (14% vs 32%; P&lt;0.05) and target lesion revascularizaion (TLR) rate (5% vs 17%; P&lt;0.05) were lower in treatment group than in control group.Conclusion Cilostazol therapy is an effective regimen for prevention not only stent thrombosis but also RR and TLR through reducing MLD without the risk of increasing bleeding.     

Effects of granulocyte colony-stimulating factor on repair of injured canine arteries

Background Endothelial progenitor cells （EPCs） derived from bone marrow may differentiate into endothelial cells and participate in endothelial repair. These cells can be mobilized into peripheral blood by cytokines, including granulocyte colony-stimulating factor （G-CSF）. In the present study, we investigated the effects of G-CSF on neointimal formation and restenosis in a canine model of arterial balloon injury.
Methods Sixteen male beagle dogs were injected subcutaneously with 20 μg·kg^-1·d^-1 recombinant human G-CSF （n=8） or normal saline （n=8） for 1 week. On the fifth day of treatment, the dogs underwent renal arterial angioplasty. At 8 weeks after arterial balloon injury, angiographic observations were made and injured arteries were processed for morphometric analysis of neointimal formation.
Results Peripheral white blood cell counts were increased by 3.34-fold compared to baseline on the fifth day of administration of G-CSF. Angiographies revealed that one stenosis had occurred among the eight injured renal arteries from dogs treated with G-CSF, whereas all injured renal arteries from dogs treated with normal saline remained patent. The mean extent of stenosis among injured arteries was 18.3%±17.9% in the G-CSF treated group compared to 12.5%±7.6% in the saline treated control group （P=0.10）. G-CSF treatment slightly increased neointimal thickness （0.42±0.15 mm vs 0.25±0.06 mm, P=-0.08） with an intima to media ratio of 0.83±0.49 vs 0.54±0.18 （P=0.11）.
Conclusions G-CSF treatment does not attenuate neointimal hyperplasia and restenosis formation in a canine model of renal arterial injury, suggesting that the therapeutic strategy for preventing restenosis by stem cell mobilization should be investigated further.     

Relationship between coronary arterial remodeling and clinical presentation

Objective To examine the relationship between coronary arterial remodeling and clinical presentation. Methods A total of 34 patients with acute (10 with recent myocardial infarction and 24 with unstable angina) and 26 with stable (8 with old myocardial infarction and 18 with stable angina) coronary syndrome underwent intravascular ultrasound (IVUS) before intervention. Target lesions were classified as soft or hard plaques. Quantitative measurements of cross-sectional area (CSA) of external elastic membrane (EEM), lumen and plaque were performed at the lesion site and at the proximal and distal reference sites. Remodeling index (RI) was expressed by the ratio of EEM CSA at the lesion site to the mean EEM CSA of both proximal and distal reference sites. Positive remodeling was defined as RI&gt;1.05 and negative remodeling as RI&lt;0.95. Results Soft plaque was observed more frequently in acute than in stable coronary syndrome (59% vs 31%), whereas hard plaque was more common in stable coronary syndrome (69% vs 41%) (P=0.03). The EEM CSA (15.11±2.89 mm(2) vs 13.25±3.10 mm(2), P=0.019) and plaque CSA (10.83±2.62 mm(2) vs 9.30±2.84 mm(2), P=0.035) were significantly greater at target lesions in patients with acute rather than stable coronary syndrome, while lumen CSA and percent area stenosis were similar in both groups. RI was significantly higher (1.08±0.16 vs 0.95±0.14, P=0.002) and positive remodeling was more frequent in acute coronary syndrome (53% vs 23%, P=0.019), whereas negative remodeling was more common in stable coronary syndrome (58% vs 24%, P=0.007). Conclusions The study indicates that clinical characteristics of patients with coronary artery disease depend largely upon underlying types of coronary arterial remodeling.     

Effect of coronary bifurcation angle on clinical outcomes in Chinese patients treated with crush stenting: a subgroup analysis from DKCRUSH-1 bifurcation study

Background Bifurcation angles may have an impact on the clinical outcomes of crush stenting. We sought to compare high （≥60°） with low （〈60°） bifurcation angle in patients who underwent either classical or double kissing （DK） crush stenting for bifurcation lesions from the DKCRUSH-1 data base.
Methods There were 212 patients with 220 lesions, some with low-angle （n=138） and some with high-angle （n=74）. Angiography was indexed at 8-month after procedure. Primary endpoint was the occurrence of major adverse cardiac events （MACEs）, defined as cardiac death, myocardial infarction and target lesion revascularization （TLR）. Secondary endpoint included late lumen loss, the rate of restenosis, and final kissing balloon inflation （FKBI）.
Results At 8 months, clinical follow-up was 100%; angiographic follow-up was 75% in the low-angle group and 83.3% in the high-angle group. There were no significant differences in the FKBI between the high-angle group （91.43%） and the low-angle group （82.39%）. In the high angle group, there was a significant difference in contrast volume used （P=0.005） but no significant difference in acute gain, minimum lumen diameter （MLD）, late loss and diameter stenosis in the pre-bifurcation segment, post-bifurcation segment or side branch. When lesions were assigned into with- （n=-133） and without-FKBI （n=42）, significant side-branch late loss was seen in the group without-FKBI （（0.65±0.49） mm vs （0.47±0.62） mm, P=0.02）, with a resultant greater restenosis rate （37.68% vs 18.32%, P=0.001）. No difference was detected in the MACE free survival rate between the high and low angle groups （82.39% vs 82.36%, P=0.84）. The rate of stent thrombosis tended to be higher in the lower-angle group although there was no significant difference （P=0.38）. The TLR free survival rate was 87.2% in the with-FKBI group vs 73.5% in the without-FKBI group （P=0.001）. Cox regression analysis showed that the independent predictors for target vessel revascularization were the side branch stent MLD post stenting （hazard ratios （HR） 1.028, 95% CI 2.357-16.233, P=0.002）, lack of FKBI （HR 4.910, 95% CI 4.706-8.459, P=0.001） and unsatisfactory kissing （HR 3.120, 95% CI2.975-5.431, P=0.001）.
Conclusions Bifurcation angles do not influence the clinical outcome of crush stenting. Successful final kissing balloon inflation, regardless of bifurcation angles, can predict TLR.     

冠心病患者血浆尾加压素Ⅱ的临床研究

OBJECTIVE: To investigate the changes in plasma urotensin II(U II) expression levels in patients with coronary heart disease (CHD). METHODS: Plasma U II levels in 50 CHD patients with coronary stenosis indicated by coronary angiography and 20 healthy subjects were determined by radio immunoassay. RESULTS: Venous plasma U II levels were significantly lowered in CHD patients in comparison with the healthy subjects (1.61+/-1.02 pg/ml vs 3.70+/-1.30 pg/ml, P=0.000). In the CHD patient group, significantly differences were noted in the U II levels between patients with stable angina (2.62+/-1.20 pg/ml), unstable angina (1.39+/-0.80 pg/ml) and acute myocardial infarction (AMI, 1.04+/-0.45 pg/ml, P=0.004). CHD patients with coronary artery occlusion and those with only coronary stenosis had comparable venous plasma U II levels (1.29+/-1.02 pg/ml vs 1.76+/-1.00 pg/ml, P=0.131), whereas the patients with restenosis after percutaneous transluminal coronary angioplasty (PTCA) had higher U II levels than the other subjects in the CHD patient group (2.28+/-0.94 pg/ml vs 1.40+/-0.96 pg/ml, P=0.008), and the femoral plasma U II levels were significantly elevated after PTCT, increasing from 1.18+/-1.14 pg/ml to a postoperative level of 2.22+/-1.77 pg/ml (P=0.001). CONCLUSION: U II might play a role in the pathophysiological process of CHD and can be involved in the restenosis after angioplasty.     

高钾饮食抗家兔血管内膜增生

目的：研究高钾饮食对血管损伤后内膜增生的抑制作用。方法：用新西兰白兔制成主动脉内皮损伤模型。实验动物分成3组：空白对照组（n=20）、对照组（n＝20）、治疗组（n=20，添加钾剂饲入：3％KCl100ml/天）。每组动物分两批于本后7天、30天处死，取腹主动脉下端作实验数据测定。结果：高钾饮食可有效升高血钾水平，治疗组服钾7天至术后30天血K+水平较空白组和对照组显著升高（P＜0.05或＜0．01）。血管条3H－TdR掺入量对照组较空白组明显升高（P＜0．05），治疗组较对照组明显下降（p＜0．05）。血管平滑肌钙含量术后7天治疗组和对照组均明显升高，尤以对照组为甚，30天后治疗组降到空白组水平，但对照组水平仍较高（P＜0．05）。新生内膜面积和内膜/中膜面积比治疗组明显低于对照组（术后7天P＜0．05，术后30天P＜0．05）。结论：高钾饮食对血管损伤后内膜增生具有明显抑制作用，提示高钾饮食对于防治球囊成形术后血管再狭窄的发生具有潜在临床应用前景。     

冠状动脉介入治疗后再狭窄的多因素分析

目的 分析冠状动脉介入治疗后再狭窄才临床易患因素的关系。方法 回顾性分析了１０３例（１２８支血管）在我院进行了经皮冠状动脉腔内形成术（ＰＴＣＡ）成功者,并于术后６个月有完整随访资料病人,通过单因素及多因素方法分析再狭窄与临床因素的关系。结果 冠状动脉再狭窄５１支,非再狭窄７７支,总再狭窄率为３９．８％（５１／１２８）。单因素分析中发现,冠状动脉内架≥３．５ｍｍ组和稳定性心绞痛组的再狭窄较低（３／２     

192Ir endovascular irradiation prevents restenosis after balloon angioplasty in rabbit

Objective　To examine the effect of endovascular irradiation on restenosis after balloon angioplasty in rabbit. Methods　After the establishment of rabbit iliac atherosclerosis model, balloon angioplasty was performed at the lesion segment of the iliac artery. Rabbits were randomly divided into three groups: control group, 10 Gy irradiated group and 18 Gy irradiated group. Endovascular irradiation was performed for irradiated groups at the dilated sites by introducing the 192Ir radioactive guidewire through a catheter. After four weeks, the animals were killed and the target segments were cut down. Histopathologic and morphometric analyses were carried out. Results　The mean final lumen area in the 18 Gy group was larger than that in the control or 10 Gy group (P&lt;0.05). The intimal area in the 18 Gy group was smaller (P&lt;0.05). Conclusions　192Ir endovascular irradiation may prevent restenosis after balloon angioplasty. The effect is related to the delivered dose. The mechanism is involved in inhibition of neointimal proliferation.     

药涂球囊成形术治疗下肢动脉闭塞性疾病的疗效及安全性的meta分析

目的采用Meta 分析方法评价药涂球囊（DCB）对比非药涂球囊（UCB）成形术治疗下肢动脉闭塞性疾病的疗效及安全 性。方法计算机检索国内外数据库中关于DCB和UCB成形术治疗下肢动脉闭塞性疾病的相关随机对照试验,按照纳入标准 和排除标准进行文献筛选和质量评价后,采用RevMan5.3软件进行Meta分析。比较两组患者术后6个月再狭窄率、晚期管径丢 失、术后1年靶病变血运重建率、术后1年通畅率、术后1年的死亡率及截肢率。结果共纳入11个试验,1853名患者共有2150 处动脉病变,其中DCB组有1110 名患者,1288 处动脉病变;UCB组有743 名患者,862 处动脉病变。Meta 分析结果显示：与 UCB组相比,DCB成形术明显降低了术后6个月的再狭窄率（15.2% vs 39.0%;OR：0.28;95%CI：0.17~0.48;P<0.000 01）、晚期管 径丢失（-0.05~0.56 vs 0.54~1.7;WMD：-0.57;95%CI：-0.93~-0.21）和术后1年靶病变血运重建率（13.0% vs 28.1%;OR：0.39;95% CI：0.23~0.64;P=0.0002）,提高了术后1 年的通畅率（71.8% vs 52.9%;OR：2.32;95%CI：1.21~4.43;P=0.001）,而两组的死亡率 （4.8% vs 5.0%;OR：1.00;95%CI：0.62~1.63;P=0.99）及截肢率（3.4% vs 2.9%;OR：1.41;95%CI：0.74~2.70;P=0.30）比较差异均 无统计学意义。结论与UCB成形术治疗下肢动脉闭塞性疾病相比,DCB成形术是一种疗效更显著,安全性无明显差异的腔内 治疗方法。     

全反式维甲酸对球囊损伤动脉后新生内膜形成及平滑肌细胞PCNA表达的影响

①目的　观察全反式维甲酸 (atRA)对球囊损伤大鼠主动脉内皮后内膜增生及血管平滑肌细胞增殖细胞核抗原 (PCNA)表达的影响 ,探讨atRA对PTCA术后再狭窄的防治作用及其机制。②方法　 5 6只大鼠随机分为假手术组、损伤组、atRA组 ,分别于术后 2、7、1 4d取实验动脉段 ,常规病理切片、苏木精 伊红染色 ,测定管腔及新生内膜面积 ,免疫组化法测定PCNA的表达水平。③结果　atRA组较损伤组 (7、1 4d时 )新生内膜横截面积明显减少 (t=3.96、- 6 .98,P <0 .0 1 ) ,内膜 /中膜横截面积比显著下降 (t=4 .2 1、- 6 .79,P <0 .0 1 ) ,在 1 4d时管腔面积明显扩大 (t=3.98,P <0 .0 1 )。PCNA于损伤后 2d在中膜见表达 ,随后表达渐少 ;损伤后 7d ,在内膜中有表达 ;1 4d可见向管腔表面聚集现象。atRA组较损伤组PCNA阳性表达指数显著下降 (t =7.2 0～ 1 5 .39,P <0 .0 1 )。④结论　atRA能抑制PCNA的过表达 ,抑制细胞周期进程 ,从而抑制内膜增生、防治再狭窄     

普罗布考对兔血管成形术后再狭窄及血管生长因子的影响

目的 :研究普罗布考 (Probucol)对兔血管成形术后再狭窄的预防作用和对生长因子表达的影响。方法 :雄性新西兰白兔2 0只 ,随机分为对照组 (C组 ) 1 0只 ,Probucol组 (P组 ) 1 0只 ,于高脂饮食 1周后行髂动脉球囊拉伤术 ,术后 C组单纯予高脂饮食喂养 ,P组予 Probucol每只 1 0 0 0 m g/ d喂养 ,各组均给予 4周药物。于实验第 1、8、2 1、35天行血脂检查 ,术后 4周行血管形态学检查及检测胰岛素样生长因子 - I受体 (IGF- IR)、血管内皮生长因子 (VEGF)、增殖细胞核抗原 (PCNA)。结果 :两组间各时点血脂浓度差异无统计学意义。与 C组相比 ,P组管腔面积明显扩大 (P <0 .0 1 ) ,内膜 +中膜面积明显减少 (P <0 .0 5 ) ,IGF- IR、VEGF和 PCNA表达明显减少 (P <0 .0 1 )。结论 :Probucol可以显著减轻兔血管成形术后再狭窄的形成 ,抑制 IGF-IR、VEGF和 PCNA的表达