国产雷帕霉素药物涂层支架在经皮冠状动脉介入术中的应用

经皮冠状动脉介入治疗(PCI) 对于冠心病(CHD)患者的疗效和安全性已得到肯定,但术后支架内再狭窄发生率较高;使用进口雷帕霉素药物涂层支架可显著降低支架内再狭窄发生率,但费用昂贵.2006年1月～2007年12月,我们采用国产Firebird雷帕霉素药物涂层支架为30例冠心病患者行PCI,效果满意.现报告如下.     

药物洗脱支架联合替罗非班治疗老年急性冠状动脉综合征患者的疗效评价

经皮冠状动脉介入(PCI)进行血运重建是治疗急性冠状动脉综合征(ACS)的主要方法之一.国产药物洗脱支架Firebird是在Mustang支架上涂有西罗莫司(雷帕霉素)、抗血小板聚集药西洛他唑(cir-ogtazol)以及控制药物释放的聚合物以降低支架内再狭窄的发生率和防止支架内血栓形成.国产抗血小板药物血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班(欣维宁,武汉远大制药集团有限公司,国药准字H20041165)对减少PCI术中、术后急性及亚急性血栓并发症具有重要作用.本研究采用Firebird术中、术后联合替罗非班治疗老年ACS患者,研究其安全性及有效性.     

丙丁酚防治经皮冠状动脉介入治疗术后再狭窄的研究进展

经皮冠状动脉介入治疗（percutaneous coronary interventions,PCI）术已经广泛应用于冠状动脉粥样硬化性心脏病（coronary atherosclerotic heart disease,CAD）的治疗,减少急性心肌梗死发生及心绞痛发作,提高患者的生活质量,显著降低死亡率。药物洗脱支架的应用,显著降低了PCI术后再狭窄率和靶血管重建率,使术后6个月内再狭窄率〈10％。     

经皮腔内冠状动脉介入治疗术后支架内再狭窄的病因分析及治疗

虽然药物涂层支架及抗凝药物的应用降低了经皮腔内冠状动脉介入治疗(PCI)术后支架内再狭窄(in-stent restenosis,ISR)的发生率,但临床研究表明仍有5%~20%的患者发生ISR。该文主要介绍药物涂层支架的ISR病因及临床治疗选择。     

药物洗脱支架的临床研究进展

药物洗脱支架通过释放一种或多种生物活性物质至血流和周围组织,抑制炎症反应和细胞增殖、延缓血管内皮化,使经皮冠状动脉介入术(PCI)术后的支架再狭窄率显著降低,并大大拓展了PCI的适应证,为冠心病患者带来了福音.本文就目前临床使用的两种药物洗脱支架(雷帕霉素、紫杉醇)的临床研究进展作一介绍.     

血糖水平与冠状动脉支架植入术后再狭窄发生率的分析

目的分析血糖水平与冠状动脉支架植入术(PCI)后再狭窄发生率的相关性以及应对措施。方法收集我院收治的行PCI的患者258例,根据患者的血糖情况将患者分为高血糖组(n=82)和血糖正常组(n=176),于术后8～12个月对患者进行随访,比较两组患者术后支架内再狭窄的情况。并根据冠状动脉造影结果将患者分为术后再狭窄组(n=56)和未狭窄组(n=202),记录并对比两组患者的空腹血糖(FPG)、糖化血红蛋白(Hb Alc)、血脂、血压水平以及吸烟情况。采用Logistic多因素回归分析探讨血糖水平是否与PCI术后再狭窄有关。结果高血糖组患者发生术后再狭窄38例(46. 34%)明显高于血糖正常组患者18例(10. 23%),差异有统计学意义(P 0. 05);术后再狭窄组患者的FPG、Hb Alc、TC、TG、HDL、LDL水平均明显高于未狭窄组(P 0. 05),术后再狭窄组患者的高血压病比例明显高于未狭窄组(P 0. 05),两组患者的吸烟史无明显统计学意义(P 0. 05);将支架内再狭窄(否=0,是=1)作为因变量,将FPG和Hb Alc作为自变量进行多因素Logistic回归分析,结果显示,FPG和Hb Alc均是PCI术后支架内再狭窄的独立危险因素(P 0. 05)。结论血糖、Hb Alc均是患者行PCI术后发生支架内再狭窄的独立危险因素,高血压与高血脂也与术后发生支架内再狭窄的发生密切相关。临床上应积极采取措施控制患者血糖、血压和血脂水平,以减少支架内再狭窄的发生。     

冠状动脉CT血管造影对支架评价的研究进展

正经皮冠状动脉内介入治疗(percutaneous coronary intervention,PCI)是冠心病的主要治疗方法之一,但术后支架内再狭窄的发生率较高,研究显示使用金属裸支架再狭窄发生率为11%~40%,即使采用药物洗脱支架,其再狭窄的发生率虽然降低,但仍然不可忽视[1],因此术后随访和评价显得尤为重要。冠状动脉造影(coronary angiography,CAG)是评     

冠状动脉粥样硬化性心脏病患者择期支架植入术前血浆超敏C反应蛋白水平对术后6个月支架内再狭窄及12个月急性冠脉事件发生的预测价值

目的 探讨冠状动脉粥样硬化性心脏病(简称冠心病)患者支架植入术前血浆超敏C反应蛋白(hs-CRP)水平与术后6个月支架内再狭窄及12个月急性冠脉事件发生的关系.方法 选择2007年10月～2010年2月我院住院的行经皮冠状动脉介入治疗(PCI)的冠心病患者358例,通过测定支架植入术前患者血浆hs-CRP水平,初步采用Logistic回归分析冠心病患者术前hs-CRP水平和PCI术后6个月后支架内再狭窄和随访12个月急性冠脉事件发生的关系.结果 血浆hs-CRP水平和PCI术后随访12个月急性冠脉事件高度相关(OR=2.21,P ＜0.01);血浆hs-CRP水平和PCI术后6个月支架内再狭窄无明显相关(OR=1.17,P ＞0.05).结论 冠心病患者支架植入术前血浆hs-CRP水平和PCI术后急性冠脉事件的发生密切相关,但是和PCI术后支架内再狭窄无明显相关,支架植入术前血浆hs-CRP水平对PCI术后急性冠脉事件的发生有较好的预测价值.     

利用Coroflex Delta支架进行经皮冠状动脉介入治疗

在经皮冠状动脉介入治疗(PCI)中,急性和亚急性支架内血栓形成会使得病例的治疗成功率降低大约0 8%～2 % ,并且提高再狭窄率2 5 %～35 %。本研究的目的旨在调查PCI中未涂药物的Coroflex Delta支架(BraunAG ,Melsungen)的临床成功率,以及PCI术后6周观察期内预期发生临床事件的概     

妊娠相关血浆蛋白A、高敏C反应蛋白与冠脉再狭窄的关系

目的：探讨妊娠相关血浆蛋白A（PAPP—A）。高敏C反应蛋白（hs—CRP）与经皮冠状动脉介入治疗（PCI）术后再狭窄的关系。方法：选择71例接受PCI治疗并于PCI术后6个月复查冠脉造影的患者,经冠脉造影证实出现支架内再狭窄的患者14例（再狭窄组）,未出现再狭窄的患者57例（无再狭窄组）,测定入选患者PCI术前和术后血浆PAPP-A,hs—CRP水平并分析其支架内再狭窄情况。结果：再狭窄组患者术后血浆PAPP—A,hs—CRP水平较无再狭窄组显著升高（P〈0．01）,且术后PAPP—A,hs—CRP水平与PCI术后冠脉后期内径丢失指数呈正相关（r＝0．57,P〈0．01）。结论：PCI术后血浆PAPP-A,hs—CRP水平可以预测冠脉再狭窄的发生。     

Percutaneous coronary intervention in patients with essential thrombocythemia: case reports and literature review

Abstract

Essential thrombocythemia (ET) can cause systemic vascular thrombosis, but the involvement of coronary arteries is rare. This study is aimed to analyze the characteristics, treatment, and prognosis during follow-up in patients with ET after percutaneous coronary intervention (PCI). A total of eight patients with ET who had coronary heart disease and treated with PCI in our hospital from 2012 to 2018 were retrospectively studied. The basic clinical information with clinical data, data of coronary intervention, application of anti-platelet and platelet reducing drugs, and the results of long-term follow-up were recorded. There were five males and three females with a median age of 67 years. Clinical presentation was unstable angina in four cases, stable angina in one case, ST-elevation myocardial infarction in two cases, and non-ST elevation myocardial infarction in one case. The average platelet count was 722 × 10⁹/L in admission, and hydroxyurea was used in seven cases. Coronary angiography suggested that all eight cases were single-vessel lesion. All the patients received PCI treatment, and Drug-eluting stent (DES) was used in all cases. Six were treated with one stent, one was treated with two stents and one was treated with three stents. After PCI, aspirin, and clopidogrel (or ticagrelor) were used in all cases. During the follow-up, one developed stent thrombus 2 months later, two developed stent restenosis 1 year later. In conclusion, PCI is an effective method of revascularization in patients with ET; but it may be associated with a higher rate of complications including stent thrombus and restenosis.     

The correlation between the level of Lp-PLA2 and coronary instent restenosis after PCI

Background Coronary in-stent restenosis(ISR) is an important complication of percutaneous coronary intervention(PCI). However, the relationship between lipoprotein associated phospholipase A2(Lp-PLA2) level and coronary ISR after PCI is rarely reported. Methods 30 patients with coronary ISR after PCI were recruited as the experimental group, 63 patients without coronary ISR after PCI were served as the control group. Lp-PLA2, hypersensitive C-reactive protein(Hs-CRP) and Low density lipoprotein cholesterol(LDL-C) were measured respectively. Smoking, hypertension, diabetes mellitus and other related factors were recorded. The relationships between these factors and restenosis of coronary stent after PCI were analyzed. Results The correlation analysis showed statistically significant(P0.05) between the level of Lp-PLA2, Hs-CRP and the restenosis of coronary stent after PCI, and that Lp-PLA2 level was an independent risk factor for coronary ISR after PCI. The correlation of Lp-PLA2 to ISR was superior to that of Hs-CRP to ISR. Conclusion The increased level of Lp-PLA2 is correlated to coronary ISR after PCI. Therefore, plasma level of Lp-PLA2 may be used as a clinically useful marker for coronary ISR prediction in patients undergoing PCI.     

冠心病患者支架置入术后再狭窄原因的临床研究

目的通过对经皮冠状动脉介入术后复查冠状动脉造影患者的回顾性分析,研究引起支架内再狭窄(ISR)的可能原因。方法入选我院2008—2011年所有复查造影的冠心病支架治疗患者210例,平均年龄(68.9±7.8)岁;男125例,女85例,将其分成支架内再狭窄组和无再狭窄组,分析两组间可能导致支架内再狭窄的因素。结果 210例患者共置入352枚支架,其中有37枚支架发生再狭窄(支架内再狭窄定义为随访时造影提示支架内管腔内径损失≥50%)。分析两组临床资料特征及支架长度、直径,是否为药物涂层支架等因素;支架内再狭窄组及无再狭窄组在脂蛋白(a)、支架长度、和药物/非药物支架方面有显著差异(P<0.05)。Cox比例风险回归模型显示仅支架长度(P=0.007)、直径(P=0.022)和药物/非药物支架(P=0.036)为冠心病介入患者发生ISR的预测因子。结论冠状动脉支架置入后发生再狭窄的主要原因为支架长度、直径及是否为药物支架。     

The risks and benefits of drug-eluting stents in the setting of STEMI

Primary percutaneous coronary intervention (PCI) represents the treatment of choice in patients with ST-segment elevation myocardial infarction (STEMI). In randomized trials excluding STEMI patients, using drug-eluting stents (DES) significantly reduced angiographic restenosis and target vessel revascularization compared with bare metal stents (BMS); however, concerns exist regarding an increased follow-up incidence of stent thrombosis after DES implantation. This complication, which is associated with higher mortality and morbidity rates, may be more frequent among STEMI patients receiving DES versus BMS. Various registries, randomized trials, and two recent meta-analyses on patients undergoing primary PCI have shown that using DES is safe and is associated with significantly reduced rates of restenosis and repeat intervention without an increased risk of myocardial infarction or stent thrombosis at intermediate-term follow-up. However, large trials with hard clinical end points and longer follow-up are needed before routine DES use can be recommended in patients undergoing primary PCI.     

H-FABP对冠脉支架术后近期心血管事件的预测

目的观察心肌脂肪酸结合蛋白对冠状动脉支架术后近期心血管事件的预测价值。方法入组90例成功择期PCI的冠心病患者,测定其冠脉支架术后3～6h内的H-FABP,并术后随访6个月,以发生心脏事件(包括心源性猝死,血管内再狭窄,充血性心力衰竭)为研究终点。结果经过6个月的随访,共有26例发生了心血管事件,其中心源性猝死1例,血管内再狭窄10例,充血性心力衰竭15例。心脏事件组H-FABP阳性率较无心血管事件组增高(P<0.05);Cox模型多因素逐步分析显示H-FABP阳性是冠脉支架术后再发心脏事件的独立危险因子(RR=5.82,P<0.05;95%CI 1.37～24.73)。结论 H-FABP阳性增加CHD患者支架术后6个月内发生心脏事件的风险,H-FABP阳性是冠心病冠脉支架术后心脏事件的独立危险因子。     

光学相干断层成像在冠心病介入治疗中的应用价值

目的应用光学相干断层成像（OCT）技术评价冠状动脉内粥样硬化斑块、血管对置入支架后即刻和中远期的反应。方法20例冠心病患者,有22支血管在完成冠状动脉造影或介入治疗后进行OCT成像。同时获取23个支架OCT成像,在23个支架中有15个为支架术后4～35个月随访,其中7个为雷帕霉素药物洗脱支架,8个为金属裸支架,另外8个为支架置放后即刻成像。结果入选的20例患者均成功进行OCT检查,并获取22支血管和23个支架满意的图像。通过OCT成像清晰地显示8处纤维斑块、3处钙化斑块、9处富含脂质斑块、2处血栓形成、斑块破裂3处及血管壁上夹层、粥样硬化斑块微小裂口和夹层等。7个置入雷帕霉素药物洗脱支架后OCT随访,均未发现有明显再狭窄,支架表面有少量内膜覆盖,部分支架表面没有内膜覆盖,其中1个支架血管出现瘤样扩张、支架与血管壁分离、支架表面没有内膜覆盖,有1个支架没有充分扩张。8个金属裸支架后用OCT随访发现,所有置入金属裸支架后支架表面内膜增殖明显,其中有3个支架因为内膜过度增殖而出现再狭窄,并再次接受介入治疗。8个支架术后即刻OCT检查显示,与血管贴壁均良好、支架扩张充分有3个支架,4个支架充分扩张,但可见到斑块裂片通过支架网眼突入管腔,1个支架支撑杆分布不均,可见支架与血管壁分离,在8个支架中有2个为支架内套叠支架。结论OCT成像技术可清晰显示各种冠状动脉粥样斑块情况,并可用于评价冠状动脉介入治疗的效果。     

Effect of elevated homocysteine levels on clinical restenosis following percutaneous coronary intervention

Since hyperhomocysteinemia confers a prothrombotic effect and promotes proliferation of smooth muscle cells in response to vascular injury, it might be implicated in the pathogenesis of restenosis after percutaneous coronary intervention (PCI). Our study comprised 55 patients who underwent successful PCI in the acute myocardial infarction (AMI) course. Homocysteine levels were determined within 24 h of admission. During a 1-year follow-up, 16 patients (31%) underwent repeated coronary angiography for recurrent angina or re-infarction, which demonstrated re-narrowing of > or =50% at the qualifying PCI site (clinical restenosis). Irrespective of stent deployment, clinical restenosis was not associated with higher homocysteine levels (12 +/- 7 vs. 14 +/- 11 micromol/l, p = 0.77). There was no correlation between homocysteine levels and time to restenosis (r(2) = 0.06, p = 0.35). In conclusion, elevated homocysteine levels do not predict a higher incidence of restenosis after PCI.     

An angiographic evaluation of restenosis rate at a six-month follow-up of patients with ST-elevation myocardial infarction submitted to primary percutaneous coronary intervention

BACKGROUND: Percutaneous coronary intervention (PCI) is considered to be the optimal type of revascularization in patients with ST-segment elevation myocardial infarction (STEMI). However, the long-term effectiveness of this procedure can be reduced by restenosis. This investigation was aimed at a prospective evaluation, in a group of STEMI patients of "the real world" (not involved in randomised trials), of the angiographic restenosis rate at a 6-month follow-up, and at identifying the relationship between restenosis and the patients' characteristics. MATERIALS AND METHODS: Our study population consisted of 123 patients with STEMI submitted to primary PCI to then undergo stress echocardiography 3 months after PCI and an angiographic evaluation at a 6-month follow-up. RESULTS: a) In real life the restenosis rate is quite high (42.3%); b) no correlation was found between patients' clinical characteristics and restenosis; c) restenosis rate was higher in patients with bare metal stents than in those with drug-eluting stents (55.8% vs. 11.1%; p<0.001); in patients with longer stents (21.6+/-8.62 vs 18.1+/-6.34 mm, p=0.015) and when more than one stent was implanted. Moreover, a consistent number of patients showed restenosis though asymptomatic. CONCLUSIONS: Our data suggest that primary PCI is associated with a high incidence of angiographic restenosis. No correlation was found between patients' clinical characteristics and restenosis. The length and the number of implanted stents seem to be associated with a more probable restenosis at six-month angiographic evaluation. Drug-eluting stent implantation seems to be associated with a lower incidence of restenosis even in STEMI patients.     

雷帕霉素药物洗脱支架治疗急性心肌梗死六个月随访结果

目的探讨雷帕霉素药物洗脱支架（Cypher）在急性ST段抬高心肌梗死急诊经皮冠状动脉介入治疗（PCI）中应用的安全性和有效性.方法选择2002年11月至2004年12月间的急性ST段抬高心肌梗死患者168例,于发病12 h内行急诊PCI治疗,于梗死相关血管的靶病变置入Cypher支架.记录1个月和6个月随访终点时的主要心脏不良事件（包括死亡、再发心肌梗死、靶血管再成形等）发生率、支架内血栓发生率、支架内再狭窄发生率.结果 168例患者急诊PCI治疗均获得成功.168支梗死相关血管的171处罪犯病变共置入175枚Cypher支架,未发生与介入治疗有关的并发症.1个月随访终点时死亡3例（死亡率1.8%）;支架内亚急性血栓1例;主要心脏不良事件发生率2.4%.6个月随访终点时死亡4例（死亡率2.4%）;主要心脏不良事件发生率4.2%;支架内血栓发生率1.2%;支架内再狭窄发生率1.8%.结论药物洗脱支架（Cypher）在急性ST段抬高心肌梗死急诊PCI中应用与普通支架一样有较强的安全性和有效性,并可以明显降低再狭窄率.     

77例冠心病PCI术前后C反应蛋白水平变化

目的探讨C反应蛋白(CRP)水平与冠心病的相关性以及行经皮冠状动脉介入治疗(PCI)术后的变化。方法采用酶联免疫吸附试验(ELISA)法测定经冠状动脉造影确诊的77例冠心病患者及78例冠状动脉造影正常者的血清CRP水平,并比较77例冠心病患者PCI术前后的血清CRP水平变化。结果冠心病患者血清CRP水平明显高于冠状动脉造影正常者,另外冠心病患者PCI术后血清CRP水平明显高于术前。结论CRP与冠心病发生密切相关;PCI能导致冠心病患者的内皮损伤,加重炎症反应,从而引起管腔再狭窄,因此PCI术后应加强抗炎治疗。