雷帕霉素药物洗脱支架对糖尿病小型猪冠状动脉支架置入后内膜增生的影响

目的:评估雷帕霉素药物洗脱支架(SES)对糖尿病小型猪冠状动脉支架置入后内膜增生的作用.方法:建立链脲菌素诱导的糖尿病小型猪模型(糖尿病组,n=12),随机选取2支冠状动脉置入SES,共计置入24枚支架,术后饲养6个月,与非糖尿病置入SES支架的小型猪模型(对照组,n=12)比较冠状动脉造影、血管内超声及组织切片检查结果.结果:两组动物支架置入冠状动脉分布,术前参照血管直径糖尿病组:(2.78±0.35)mm,对照组:(2.81±0.29)mm]及术后即刻最小管腔内径糖尿病组:(2.90±0.42)mm,对照组:(2.89±0.33)mm]均相似(P均>0.05).术后6个月糖尿病组支架内狭窄程度(35.6±9.2)%和(7.9±3.1)%,P<0.001]、支架内晚期管腔丢失(0.32±0.09)mm和(0.09±0.04)mm,P<0.001]、新生内膜厚度血管内超声:(0.35±0.12)mm和(0.11±0.08)mm,P<0.05]及新生内膜面积血管内超声:(1.29±0.51)mm~2和(0.26±0.11)mm~2,P<0.001;组织切片:(1.24±0.76)mm~2和(0.19±0.08)mm~2,P<0.05]均显著高于对照组.结论:糖尿病小型猪冠状动脉置入SES后内膜增生程度显著高于无糖尿病模型.

Effect of Rapamycin Eluting Stent for Inhibition of Neointimal Hyperplasia in Diabetic Porcine Model

Objective:To investigate the effect of rapamycin eluting coronary stent for inhibition of neointimal hyperplasia in diabetic porcine model.Methods:There were two groups in this study. Diabetic group, n=12, diabetic porcine model was established by a single dose of streptozotocin, and rapamycin eluting coronary stents were randomly implanted into 2 of the major epicardial coronary arteries. Control group, n=12, with non-diabetic porcine. The degree of neointimal hyperplasia evaluated by coronary angiography, intravascular ultrasound (IVUS) and histopathology were compared between two groups respectively at 6 months of the event. Results:The distribution of vessels received stents, reference vessel diameters and post-procedural minimal luminal diameter were comparable between two groups. All animals received angiographic follow-up at 6 months of time. In Diabetic group, the degree of stent stenosis (35.6%±9.2% vs. 7.9%±3.1%,P<0.001), late lumen loss (0.32±0.09 mm vs. 0.09±0.04 mm,P<0.001), the thickness of neointima by IVUS examination (0.35±0.12 mm vs. 0.11±0.08 mm,P<0.05) and area stenosis by IVUS (1.29±0.51 mm~2 vs. 0.26±0.11 mm~2, P<0.001); and histopathological examination (1.24±0.76 mm~2 vs. 0.19±0.08mm~2, P<0.05) were significantly higher than those in Control group. Conclusion: The neointimal hyperplasia after rapamycin eluting stent implantation was significantly severe in the diabetic porcine models than those in non-diabetic ones.