冠状动脉支架术后再狭窄与妊娠相关蛋白A的关系

目的 探讨冠状动脉粥样硬化性心脏病(冠心病)患者支架术后再狭窄与妊娠相关蛋白A(PAPP-A)的关系.方法 选择冠状动脉内支架术6～12个月后进行复查的132例冠心病心绞痛患者为对象,其中前降支病变62例,回旋支36例,右冠状动脉34例,进行冠状动脉造影检查,以冠状动脉造影狭窄率≥50%为支架内再狭窄.测定PAPP-A的浓度,将患者分为高PAPP-A组(PAPP-A≥12.11 mlU/L)66例和低PAPP-A组(PAPP-A＜12.11 mIU/L)66例,通过血管内超声波(IVUS)检查,观察两组冠状动脉支架术后新生内膜面积、新生内膜体积.结果 132例冠状动脉造影示再狭窄42例(31.8%),再狭窄组和无再狭窄组患者年龄、性别、冠状动脉疾病危险因素比较,差异无统计学意义.再狭窄患者PAPP-A水平高于无再狭窄的患者,分别为(18.14±2.26)mIU/L与(10.95±2.12)mIU/L,差异有统计学意义(P＜0.01).高PAPP-A组再狭窄率为42.4%(28例),低PAPP-A组为21.2%(14例),两组差异有统计学意义(P＜0.01).相关分析显示,PAPP-A与新生斑块面积及体积呈正相关(r分别为0.47及0.54,P＜O.05).结论 PAPP-A与内膜增生有关,PAPP-A可能通过促进新生内膜增生而引起支架术后再狭窄.

Relationship between pregnancy-associated plasma protein A level and restenosis after elective coronary stenting

Objective To investigate the relationship between pregnancy-associated plasma protein A(PAPP-A)level and restenosis after elective coronary stenting by coronary artery angiography(CAG)and intravascular ultrasound(IVUS). Methods The study consisted of 132patients with successful coronary stent placement:left anterior descending coronary artery(LAD)62,left circumflex coronary artery(LCX)36,right coronary artery(RCA)34.The follow-up CAG and IVUS were Derformed at the 6th month after stent placement.Diameter stenosis≥50%on CAG was regarded as in-stent restenosis.Neointimal areas(IA),stent volume(SV)and neointimal volume(IV)were measured by IUVS during follow-up.According to the PAPP-A level,lesions were divided into 2groups:high PAPP-A group(PAPP-A level≥12.11 mIU/L)and low PAPP-A group(PAPP-A level＜12.11 mIU/L). Results Total restenosis rate was 31.8%.There were no significant differences in age.sex and risk factors of coronary heart disease(hypertension,diabetes,smoking)between restenotic and nonrestenotie groups(all P＞0.05).The restenotic group had higher PAPP-A level than nonrestenotic group(18.14±2.26)mIU/L vs. (10.95±2.12)mlU/L,P＜0.01].Angiographic restenosis occurred in 28 of 66 lesions(42.4%)in the high PAPP-A group and in 14 of 66 lesions(21.2%)in the low PAPP-A group(P＜0.01).Plasma PAPP-A level was positively correlated with IA,IV(r=0.47 and 0.54 respectively,all P＜0.05). Conclusions Elevated PAPP-A level is correlated well with the severity of the intimal hyperplasia.Plasma PAPP-A level affects restenosis after elective stent placement by promoting intimal hyperplasia.