地塞米松干预对不同数目冠状动脉支架植入后高敏C反应蛋白水平的影响

目的 探讨冠状动脉内植入不同数目支架术后血清高敏C反应蛋白(hsCRP)水平的变化规律及地塞米松对hsCRP水平的影响.方法 77例患者随机分为实验组(46例)和时照组(31例).实验组植入冠状动脉支架术后立即静脉注射地塞米松10 mg;对照组仅植入冠状动脉支架.实验组与对照组每组再分别依据植入支架数目不同分为单枚支架和多枚支架(2～4枚)2个亚组;分别于冠状动脉支架植入术前、术后6小时、12小时、24小时、48小时及72小时留取外周血,检测血清hsCRP值,分组对比研究.结果 ①实验组术后hsCRP水平与术前比较差异无统计学意义(P>0.05);对照组术后hsCRP水平与术前比较差异有统计学意义(P<0.01),hsCRP从术后6小时开始升高,48小时达高峰,持续至72小时开始下降,分别为1.50(3.40)mg/L vs 3.10(5.80)mg/L,10.90(17.30)mg/L,6.50(13.80)mg/L(P<0.01).两组间比较对照组术后多个时点hsCRP水平高于实验组(均P<0.01).②对照组多枚支架和单枚支架亚组术后hsCRP水平与术前比较均升高,但多枚支架亚组术后hsCRP升高更早,幅度更高,持续时间更长.③实验组多枚支架和单枚支架两亚组术后hsCRP与术前比较差异无统计学意义(P>0.05);两亚组间比较多枚支架亚组于术后多个时点hsCRP水平高于单枚支架亚组(P<0.05).结论 术后即刻一次静脉应用10mg地塞米松能有效抑制冠状动脉支架植入术后的炎症反应,但对于植入多枚支架患者试图将hsCRP降到理想水平有待进一步探讨.

Change study of hsCRP with dexamethasone intervention after different numbers of coronary stent implantation

Objective To investigate changes in serum high-sensitivity C-reactive protein（hsCRP） concentration after different numbers of coronary stent implantation and influence of dexamethasone to hsCRP level. Methods Seventy-seven cases of patients were randomly divided into experimental group（ n = 46） and control group （n = 31）. Experimental group was immediately intravenously injected dexamethasone 10 mg after stent implantation; the control group got only coronary stent implantation. Both groups were re-divided into sub-groups based on the number of different stent implantation including single and muhi-stent（2-4） pieces of stent,respectively. Samples of venous serum in all groups were obtained to determine the hsCRP concentration before stent implantation and 6 h, 12 h, 24 h, 48 h, 72 h after stent implantation for comparative study. Results ①Compared with the preoperative hsCRP values,there were no significant differences within experimental group at each time point after stenting（ P 〉0.05）. Compared with the preoperative values, the hsCRP in control groups 6 hours after stenting began to increase,48 hours reached a peak, 72 hours began to decrease,1.50（3.40） mg/L vs 3.10（5.80） rag/L,10.90（17.30） mg/L,6. 50（13. 80） mg/L,there were significant differences （ P 〈 0.01 ）. There were significant differences in hsCRPs values between experimental and control groups after stenting（all P 〈0.01）, the level of hsCRP in control group was higher than that of experimental group multiple points after stenting. ②Compared with the preoperative, the hsCRP value after stenting in two subgroups of control groups all were increased, there were significant differences（ P 〈0.05）. hsCRP after stenting increased earlier, showed higher concentration,longer duration in multi-stent sub-group. ③ Respectively compared with the preoperative hsCRP values,there were no significant differences within two sub-groups of experimental group after stenting（ P 〉0.05）. There were significant differences in hsCRP values between two sub-groups（ P 〈0.05） ,the level of hsCRP in multi-stent subgroup was higher than single stent subgroup at multiple points after stenting. Conclusion Immediately one time intravenous injection of dexamethasone 10 mg after stenting can effectively inhibit the inflammatory reaction after coronary stent implantation, however, the attempt of more than one stent implantation patients＇ hsCRP down to desired level will be further explored.