不同支架对冠心病患者介入术后炎症因子的影响

目的比较药物洗脱支架与普通支架植入前后冠心病患者血超敏C反应蛋白（hs-CRP）、白细胞介素-6（IL-6）、P选择素（P-selectin）、可溶性细胞间黏附分子（sICAM-1）的变化,探讨其意义。方法选择有支架植入指征的冠心病患者66例,随机分为药物支架组和普通支架组,30例置入支架Cypher（Cypher支架组）,36例置入普通Bxsonic支架（普通支架组）。分别于手术前,术后即刻,术后6h、术后24h、7d取肘静脉血,采用ELASA法检测IL-6、P选择素、slCAM-1、hs-CRP。结果Cypher支架组与普通支架组比较P选择素、IL-6、slCAM-1、hs-CRP水平在扩张前、术后即刻没有显著性差异,而术后6h、24h、7d时Cypher支架各测定值显著低于普通支架组（P<0.05,P<0.01）。结论Cypher药物洗脱支架对冠心病患者介入术后血炎症因子的产生有抑制作用。     

雷帕霉素洗脱支架对冠心病患者介入术后血小板功能的影响

目的　比较雷帕霉素洗脱支架(CypherTM)与Bxsonic支架对冠心病不稳定性心绞痛患者血小板功能的影响。方法　选择6 2例冠心病不稳定性心绞痛患者,30例置入CypherTM 支架(CypherTM支架组) ,32例置入Bxsonic支架(Bxsonic支架组)。分别于术前、术后即刻、术后6h取冠状静脉窦血测定血小板α颗粒膜蛋白14 0 (GMP14 0 )浓度以及血小板表面GMP14 0的分子数和血小板最大聚集率(MPAR) ;分别于术前、术后2 4h、7天、1个月取肘静脉血检测上述指标。结果　冠状窦血样显示CypherTM支架组血浆GMP14 0、MPAR和血小板表面GMP14 0表达水平在术前和术后即刻与Bxsonic支架组无明显差异,血浆GMP14 0、MPAR和血小板表面GMP14 0分子数在6h明显低于Bxsonic支架组(P <0 .0 5 ) ;外周静脉血样显示GMP14 0、MPAR和血小板表面GMP14 0分子数在2 4h、7天时CypherTM支架组高于Bxsonic支架组(P <0 .0 5 ) ,1个月时CypherTM支架组血小板表面GMP14 0分子数仍然高于Bxsonic支架组(P <0 .0 5 )。结论　CypherTM支架对冠心病患者介入术后血小板功能的影响与Bxsonic支架不同,血小板活化时间较长,应注意坚持1个月以上的抗血小板治疗。     

早期康复训练对支架置入冠心病患者血清白细胞介素6和高敏C-反应蛋白的影响

目的 观察冠心病中国产雷帕霉素药物洗脱支架(Partner支架)和进口雷帕霉素药物洗脱支架(Cypher)置入后早期康复训练对白细胞介素(IL)-6和高敏C-反应蛋白(hs-CRP)的影响.方法 收集辽宁医学院附属第三医院2009年1月至2011年12月心内科介入支架治疗急性心肌梗死患者110例.根据病变及经济情况将患者分为Partner组(n=60)和Cypher组(n=50).两组中部分患者进行早期康复训练,所有患者于支架置入前、置入后24 h,l、3 w检测血清IL-6,hs-CRP含量.结果 支架置入24h后,各组患者血清IL-6、hs-CRP水平明显高于置入前(P＜0.05).支架置入后l、3 w患者血清IL-6、hs-CRP水平与置入后24 h比较,差异无显著意义,但均明显高于置入前(P＜0.05).康复训练与未康复训练组间无显著差异(P＞0.05).结论 Partner支架和Cypher对冠心病患者血清IL-6、hs-CRP水平的影响无明显差别.冠心病患者行支架置术后血清炎症因子水平在康复训练后不能减轻.     

益心胶囊对冠状动脉支架术后再狭窄的影响

目的观察益心胶囊对冠状动脉内支架植入术后再狭窄的预防作用.方法选择支架植入成功的冠心病患者94例,随机分为益心胶囊组(41例)和常规治疗组(53例),分别于支架植入术前、术后即刻和术后30d时检测血清白细胞介素-6(IL-6)、C-反应蛋白(CRP)、血浆内皮素(ET)和一氧化氮(NO)的变化.对患者术后6个月的心脏事件、血瘀证积分值变化和冠脉造影等进行随访观察.结果与常规治疗组比较益心胶囊组IL-6、CRP和ET水平显著下降(P＜0.05),NO显著升高(P＜0.05),血瘀证积分显著降低(P＜0.05).结论益心胶囊对预防冠脉内支架植入术后再狭窄有一定作用.     

切割球囊血管成形术对不稳定性心绞痛患者血管性假血友病因子、白细胞介素-6和C-反应蛋白的影响

目的 :比较切割球囊血管成形术与普通球囊血管成形术对不稳定性心绞痛患者血浆血管性假血友病因子 (vWF)和血清白细胞介素 6(IL 6)、C 反应蛋白 (CRP)浓度的影响。方法 :选择 65例拟行冠状动脉 (冠脉 )介入治疗的不稳定性心绞痛患者 ,随机分为两组 ,分别接受切割球囊血管成形术 (切割球囊组 )或普通球囊血管成形术 (普通球囊组 ) ,球囊扩张后均放置支架。分别于术前、术后即刻、术后 2h和 6h抽取冠状静脉窦血样测定血浆血管性假血友病因子和血清IL 6的浓度 ;另于术前、术后 6h、术后 2 4h和 48h抽取肘静脉血样 ,测定血清CRP的浓度。以上指标均以酶联免疫吸附法进行测量。结果 :普通球囊组血浆血管性假血友病因子浓度术后即刻和术后 2h ;血清IL 6浓度术后即刻 ,术后 2h和 6h以及血清CRP浓度术后 6h、2 4h和 48h都明显高于切割球囊组 ,有显著性差异 (P均 <0 0 5～ 0 0 1)。结论 :单纯切割球囊血管成形术对不稳定性心绞痛患者血浆血管性假血友病因子、血清IL 6和CRP浓度的影响均小于单纯普通球囊血管成形术 ,联合支架置入术后有相似结果 ,这可能是前者通过减轻对炎症反应的影响 ,减少再狭窄及心血管事件发生的机制之一。     

不同类型药物洗脱支架介入治疗对血清C反应蛋白和白细胞介素-6水平的影响

目的:对比雷帕霉素药物洗脱支架(Cypher Select)、紫杉醇洗脱支架(Yinyi)和可降解涂层雷帕霉素药物洗脱支架(Excel)介入治疗,对不稳定型心绞痛(UAP)患者血清C反应蛋白(CRP)和白细胞介素-6(IL-6)的影响。方法:连续入选104例单支病变并接受介入治疗的UAP患者,依照置入支架种类分为Cypher组(33例)、Yinyi组(28例)和Excel组(43例)。于术前、术后48h、7d和30d时抽血,测定血清CRP和IL-6。结果:3组基本临床资料、冠状动脉介入治疗情况无明显差异。术后48h3组血清CRP和IL-6均较术前明显升高(P0.01)。3组CRP和IL-6术后7d较术后48h下降,30d时降至显著低于术前水平。3组间比较,冠状动脉介入治疗术前、术后48h、7d和30d时,CRP和IL-6水平均无明显差异。结论:3种药物洗脱支架置入均可引起短期内炎症因子水平升高,但三者间比较对炎症因子水平的影响未见明显差异。     

接受Cypher支架治疗的131例冠心病患者初步结果分析

目的评价接受雷帕霉素涂层支架(Cypher)治疗的冠心病患者近、远期疗效. 方法选择自2002年9月至2003年8月住院期间接受Cypher支架治疗的131例冠心病患者,分析患者的一般临床特点、支架植入方式及部位、患者术后即刻结果、术后3、6、9个月临床心性事件率、心绞痛复发情况及患者冠造复查情况.     

不同雷帕霉素药物洗脱支架在老年冠心病患者中的应用与研究

目的探讨雷帕霉素药物洗脱支架在老年冠心病经皮冠状动脉介入治疗中应用的安全性和有效性。方法入选320例冠心病患者,分为国产雷帕霉素药物洗脱支架组(Firebird组)160例,进口雷帕霉素药物洗脱支架组(Cypher组)160例。比较两组置入支架后6个月随访时的临床不良事件和再狭窄率。结果Firebird组共置入支架197枚,Cypher组共置入支架204枚。临床6个月随访示Firebird组临床不良事件3例,Cypher组4例,差异无显著性意义。6个月期随访造影显示Firebird组(66例)和Cypher组(77例)支架内再狭窄各出现1例。结论雷帕霉素药物洗脱支架Firebird和Cypher类似,而且Firebird有更高的效价比。     

冠状动脉内磁化支架置入术后冠状静脉窦血中NO与ET-1水平的变化

目的 :观察冠心病患者冠状动脉内置入磁化支架后冠状静脉窦血中一氧化氮 （NO）与内皮素 - 1（ET- 1）水平的变化 ,探讨磁化支架防治冠状动脉再狭窄的机制。方法 :经皮腔内冠状动脉成形术及冠状动脉内支架置入术的冠心病患者随机分为磁化支架组 （2 3例 ）及非磁化支架对照组 （16例 ）。经股静脉将 6 F右冠状动脉造影导管置入冠状静脉窦采血 ,采用 Griess法及非平衡法分别测定冠状动脉内支架置入术前及术后 6 h内冠状静脉窦血中 NO及ET- 1的水平。结果 :磁化支架组术后 6 h冠状静脉窦血中 NO含量较对照组相比显著升高 （P<0 .0 1） ;磁化支架组ET- 1水平的改变 ,包括术后即刻降低 P<0 .0 1)与 6 h回升 （P<0 .0 1）都不如对照组明显 ,两组 ET- 1水平在 3h有显著性差异 （P<0 .0 5 ）。结论 :冠状动脉内磁化支架置入术后 NO升高与 ET- 1水平变化趋缓反映了靶区血管局部内皮细胞功能改善 ,磁化支架置入术后急性冠脉痉挛及远期冠脉再狭窄的发生率降低可能与此有关     

冠心病患者Cypher支架与Partner支架置入术前后CRP水平的变化

目的探讨冠心病患者经皮冠状动脉介入治疗(PCI)置入国产雷帕霉素支架(Partner,乐普)与进口雷帕霉素支架Cypher术前术后血清C反应蛋白(CRP)水平的改变及临床意义。方法92例临床表现为胸闷胸痛且经冠脉造影检查确诊为冠状动脉粥样硬化狭窄程度≥70%的患者,分为Partner组和Cypher组。所有患者在术前及术后48h、72h、2周测定CRP,并临床随访造影及主要心血管事件8个月。结果两组血清CRP水平48h均较术前增高(P0.05),支架术后72hCRP持续升高的患者在随访中发生心血管事件风险增加,2周后CRP已下降,两组之间比较无统计学意义。Partner组48例患者共置入支架52枚,术后TIMI血流3级48例,成功率100%;44例接收随访,随访时间8个月,3例仍有心绞痛症状,无支架内再狭窄及心血管事件等发生。Cypher组44例患者共置入支架48枚,术后TIMI血流3级44例,临床成功率100%;40例接受随访,随访时间8个月,2例仍有心绞痛症状,无支架内再狭窄及心血管事件等发生。结论Partner支架和Cypher支架引起炎症介质CRP水平变化无统计学差异,国产Partner支架在冠心病患者中应用与Cypher支架近期具有一致的安全性和有效性。     

雷帕霉素洗脱支架对介入术后血管内皮再生的影响

目的:研究雷帕霉素洗脱支架(CypherTM)对血管内皮再生的影响。方法:杂种犬3只,经麻醉后行血管造影,选择动脉血管直径为2·25mm的直血管段在远端及近端分别置入直径为2·25mm的CypherTM支架及Bxsonic支架。术后仍继续给予抗血小板治疗,饲养30d行再次血管造影后取标本行扫描电镜检查。结果:术后30d血管造影CypherTM支架及Bxsonic支架均无管腔丢失。扫描电镜显示CypherTM支架内皮覆盖不完整,有一定的血小板黏附、聚集。Bxsonic支架内皮覆盖完整,未见血小板黏附聚集。结论:CypherTM支架内皮再生较裸金属支架缓慢,有一定的血小板激活。置入CypherTM支架的患者应进行更为严格的抗血小板治疗。     

长球囊血管成形术并长支架置入对下肢缺血者血清IL6和CRP的影响

目的：比较长球囊血管成形术联合长支架置入术（LBPTALS）与普通球囊血管成形术联合普通支架置入术（OBPTAOS）对血清IL-6和C反应蛋白（CRP）浓度的影响。方法：选择经下肢血管造影证实为股浅动脉狭窄单支病变的糖尿病下肢缺血患者43例，随机分为两组，分别接受长球囊血管成形术（LBPTA）及长支架（LS）或普通球囊血管成形术（OBPTA）及普通支架（OS）。分别于术前，术后即刻、2h和6h抽取患肢静脉血测定血清IL-6含量，另于术前，术后6、24和48h抽取患肢静脉血测定血清CRP的浓度。血清IL-6和CRP的浓度均以ELESCA双抗体夹心法进行测定。结果：两组患者靶病变情况差异无统计学意义。LBPTALS组的手术时间、夹层数、置入支架数和球囊扩张次数明显低于OBPTAOS组（P（0．05～〈0．01）。OBPTAOS组IL-6浓度在术后即刻开始高于LBPTALS组，术后2h和6h差异进一步增大（P〈0．01）。OBPTAOS组的CRP浓度在术后6，24和48h都明显高于LBPTALS组（P〈0．01）。结论：LBPTALS对糖尿病下肢缺血患者血清IL-6和C反应蛋白浓度的影响均小于OBPTAOS，前者这种减轻炎症反应的影响，可能是其减少再狭窄的机制之一。     

Increased C-reactive protein level after renal stent implantation in patients with atherosclerotic renal stenosis

Elevated C-reactive protein (CRP) level has been demonstrated in patients with coronary artery disease after coronary stent implantation, but no data are available in patients with atherosclerotic renal artery stenosis concerning whether such changes of CRP also exist after renal artery stent implantation. The authors hypothesize that elevated CRP level may also be present in patients with atherosclerotic renal artery stenosis after stent implantation owing to mechanical disruption of atherosclerotic plaque. In total, 24 patients were enrolled in this study. Of these, 14 patients with atherosclerotic renal artery stenosis received renal angioplasty plus stent implantation (group A, mean age 51 +/- 8 years), and 14 age- and gender-matched patients underwent renal angiography for diagnostic purpose as a control group (group B, mean age 50 +/- 8 years). Peripheral blood samples were taken before the procedure and at 6 and 24 hours after the procedure in both groups. Plasma CRP concentration was measured by using immunoturbidimetry. The results showed that there was no difference in clinical characteristics or in baseline CRP levels between the 2 groups. However, median CRP level was found to increase significantly at 6 hours from 0.13 to 0.17 mg/dL (p < 0.05), and peaked at 24 hours (0.21 mg/dL) after renal artery stent implantation (p < 0.001). Mean CRP rose from 0.30 +/- 0.09 to 0.37 +/- 0.15 mg/dL at 6 hours (p < 0.05) and peaked at 24 hours (0.43 +/- 0.18 mg/dL) after renal artery stent implantation (p < 0.01), while no such changes were observed after renal angiography in group B (p > 0.05, respectively, at different time points). The results of the present study indicate, from evidence of increased plasma CRP concentrations, that renal artery stent implantation could trigger an inflammatory response due to mechanical disruption of atherosclerotic plaque of the renal artery, which is a pattern very similar to that of coronary stent implantation.     

Relationship between plasma inflammatory markers and platelet aggregation in patients with clopidogrel resistance after angioplasty

We evaluated the relationship between plasma inflammation markers and clopidogrel resistance in patients after stent implantation. The plasma levels of C-reactive protein (CRP), P-selectin, platelet soluble CD40 ligand (sCD40L), interleukin 6 (IL-6) and platelet aggregation were measured in 352 patients undergoing percutaneous coronary intervention (PCI) at baseline and after 6 months. The plasma levels of CRP, P-selectin, sCD40L, IL-6 was higher in 65 (18.5%) patients with clopidogrel resistance than in those with normal responsiveness at 6 months after PCI. There was a significant positive correlation between soluble CD40L levels and platelet aggregation (r = .28, P < .05). Diabetes (DM) and sCD40L level were independent predictors for unresponsiveness after stent implantation according to stepwise multivariate analyses. The hazard ratio (HR) for sCD40L level was 3.02 (95% CI = 1.28 to 3.25; P = .036) and for DM 2.53 (95% CI = 1.28 to 6.55, P = .03). We conclude that sCD40L and DM may influence clopidogrel resistance.     

Tirofiban对犬髂动脉球囊损伤后可溶性粘附分子CD62p水平及白细胞计数的影响

目的 :观察 tirofiban对犬髂动脉球囊损伤后血浆可溶性粘附分子 CD6 2 p水平及全血白细胞计数的影响。方法 :2 4只健康成年犬随机分为治疗组 （tirofiban 30 0μg/ kg静推 ,后以 0 .3μg· kg- 1 · min- 1 静滴 6 h）和对照组 （9g/ L 盐水静滴 ） ,每组 12只。行单侧髂动脉球囊损伤 ,术前、术后即刻及 2 ,4,6 h静脉取血行全血白细胞计数 ,EL ISA法测定血浆 CD6 2 p含量 （光密度 ）。结果 :对照组球囊成形术后血浆 CD6 2 p含量增加 ,2 h后开始下降 ;而治疗组 CD6 2 p术后立即下降 ,4h后恢复至基线。全血白细胞在对照组术后逐渐增加 ;而治疗组用药后则出现一过性白细胞受抑。结论 :tirofiban除了已知的抑制 GP b/ a受体和血小板聚集外 ,还能抑制球囊成形术后血小板活化及全血白细胞。可能通过抑制 CD6 2 p（P- selectin）、抑制白细胞 -血小板间相互作用改善经皮冠状动脉介入治疗后的临床结果。     

雷帕霉素洗脱支架治疗多支冠状动脉病变的临床研究

目的:探讨多支冠状动脉病变患者置入雷帕霉素洗脱支架(Cypher支架)预防再狭窄的疗效及安全性。方法:2001年12月-2004年5月连续725例接受多支冠状动脉支架置入术的冠心病患者,剔除急性心肌梗死及再次血运重建患者。Cypher支架组187例,普通金属支架(普通支架)组538例。比较两组支架术后的近期及远期结果。结果:除糖尿病患者比例在Cypher支架组较高外,两组患者冠心病危险因素、心功能、冠状动脉病变严重程度、介入手术成功率及并发症发生率均无显著差异。690例患者平均随访(18.8±11.7)个月,Cypher支架组和普通支架组造影随访率分别为52.4%vs58.2%(P>0.05)。尽管Cypher支架组患者冠心病危险因素多、平均年龄63.5岁、不稳定性心绞痛占66.3%、糖尿病占41.6%、3支血管病变占57.8%、B2/C型复杂病变占86.2%,但造影复查再狭窄率和主要不良心脏事件(MACE)发生率均明显低于普通支架组(3.1%vs16.6%,5.5%vs16.7%,P均<0.01),心功能改善率高于普通支架组(63.1%vs30.6%,P<0.01)。两组完全血运重建率无显著差异(81.3%vs86.8%,P>0.05),但发生MACE的患者中,Cypher支架组不完全血运重建者比例高于普通支架组(60.0%vs23.5%,P<0.05);两组发生MACE的患者中完全血运重建患者比例均低于本组总的完全血运重建率(Cypher支架组:40.0%     

Carbon coating of stents has no effect on inflammatory response to primary stent deployment

The aim of this study was to investigate the effects of stent carbon coating on inflammatory response. The authors serially measured plasma concentrations of C-reactive protein (CRP), fibrinogen, and several cytokines (tumor necrosis factor, interleukin [IL]-1-beta, IL-6, and IL-8) in patients with single-vessel coronary stenosis who underwent primary stent implantation. None of the subjects had inflammatory or infectious disease at the time of the procedure. Forty-six patients (38 males; mean age 55 +/-9 years) were studied. Blood samples were collected before and at 2, 4, 6, 24, and 48 hours after stent implantation. Patients were randomly assigned 1 of 2 different stent types, an uncoated MAC (AMG Raesfeld-Erle, Germany) (UC-MAC) or a carbon-coated MAC (CC-MAC) stent. Implantations were performed without predilatation, and stents were deployed at a maximum pressure of 6 atmospheres for 90 seconds. Of the 46 patients, 14 had stable, 27 had unstable, and 5 had atypical angina. According to ACC/AHA classification, 35 lesions (76.1%) were type A, 10 (21.7%) were type B, and 1 (2.2%) was type C. Single stenosis of 28 left anterior descending, 12 circumflex, and 6 right coronary arteries were treated. Serum IL-6 increased in both the UC-MAC and CC-MAC groups, with concentrations significantly elevated above baseline at 6 hours, and then decreasing after 24 hours (baseline, 6-hour, and 24-hour values = 3.1 +/-2.3, 5.7 +/-3.8, and 6.3 +/-4.6 pg/mL, respectively, in UC-MAC; 3.7 +/-2.6, 6.2 +/-6.0, and 4.6 +/-3.7 pg/mL, respectively, in CC-MAC [p=0.002]). Plasma fibrinogen, CRP, and leukocyte concentrations also increased in both groups over the 24 hours (p < 0.05). The elevations of IL-6, CRP, and fibrinogen were similar in the 2 groups. The percent increases in IL-6, fibrinogen, and CRP were not associated with stent length, size, or clinical presentation (all p > 0.05). The results showed that stent implantation increases plasma IL-6, fibrinogen, and CRP concentrations, but carbon coating of the stent does not seem to affect this inflammatory response.     

Serum levels of circulating adhesion molecules after coronary angioplasty.

The activation of platelets, leukocytes, and vascular endothelial cells mediated by cell adhesion molecules may play a role in the mechanism of restenosis, which is still a significant complication after coronary angioplasty. We observed serial changes in the circulating soluble forms of adhesion molecules in 25 patients with coronary artery disease who underwent coronary angioplasty for a single lesion of the left anterior descending artery. Serum levels of sICAM-1 (p < 0.05) and sP-selectin (p < 0.05) were significantly increased immediately after angioplasty in the coronary sinus blood samples. These increases continued during the 48-hour observation period, and the maximum increase was seen 48 h after angioplasty for sICAM-1 (p < 0.01) and 24 h after angioplasty for sP-selectin (p < 0. 01). The level of sL-selectin increased 24 h (p < 0.01) and 48 h (p < 0.001) after angioplasty. These changes were not observed in the peripheral blood samples. The sE-selectin level did not change after angioplasty. A multiple regression analysis showed that the late loss index obtained from quantitative angiographic (QCA) analysis was correlated with the changes in sICAM-1 (r = 0.31, p < 0.05), sL-selectin (r = 0.28, p < 0.05), and sP-selectin (r = 0.26, p < 0. 05) 48 h after angioplasty in the coronary sinus blood samples, but was not correlated with procedural variables, other QCA variables, or the change in the sL-selectin level. The measurements of these adhesion molecule levels may help to evaluate traumatic vessel wall injury and inflammation at the intervention site after coronary angioplasty.     

切割球囊血管成型术对C-反应蛋白白细胞介素-6及细胞间粘附分子的影响

目的 :比较切割球囊预扩张与普通球囊预扩张后支架置入术对C 反应蛋白 (CRP)、白细胞介素 6 (IL 6 )及可溶性细胞间粘附分子 1(sICAM 1)的影响。方法 :将冠状动脉造影显示单纯前降支近端病变的不稳定型心绞痛患者分为 2组 ,一组给予普通球囊预扩张后支架置入 ,另一组给予切割球囊预扩张后支架置入 ,并分别在术前、术后 1、6、2 4、4 8h测定C 反应蛋白、白细胞介素 6及可溶性细胞间粘附分子的浓度。结果 :2组患者一般情况、病变情况无显著统计学差异 ,术后 6hC 反应蛋白、白细胞介素 6较术前升高 ,2 4h达高峰 ;可溶性细胞间粘附分子术后 1h较术前升高 ,术后 6h达高峰。切割球囊组C 反应蛋白、白细胞介素 6水平在术后 6、2 4、4 8h均显著低于普通球囊组 ,可溶性细胞间粘附分子水平在术后 1、6、2 4、4 8h低于普通球囊组。介入治疗中切割球囊组球囊最大充盈压 (MIP)明显低于普通球囊组。结论 :切割球囊血管成型术对C 反应蛋白、白细胞介素 6及可溶性细胞间粘附分子的影响小于普通球囊组 ,可能是切割球囊降低术后再狭窄的机制之一