颈动脉内支架置入后家兔血小板活化及相关因子的变化

背景：关于炎性反应和炎症因子与颅内外血管狭窄支架成型后发生血管再狭窄的研究中涉及其病理生理机制各家说法不一。 目的：观察家兔颈动脉内支架置入后血小板活化及相关因子的变化。 设计、时间及地点：观察性实验，于2008-03/09在河南大学神经生物研究所完成。 材料：家兔26只，雌雄不拘，体质量2.1~2.9 kg；国产铂铱合金支架由铂90%和10%铱合金制成，为金属丝直径0.13 mm单丝缠绕的螺旋形结构。将支架浸入100 g/L明胶溶液中经干燥后制成明胶蛋白涂层支架。 方法：动物用戊巴比妥钠麻醉(30 mg/kg)，分离暴露右侧颈动脉，将支架置入右颈动脉近端，置入后给予青霉素80万 IU/d静脉注射，置入前应用阿司匹林和氯吡格雷的双抗血小板治疗。 主要观察指标：支架置入前即刻、置入后0.5 h，6 d，1个月和6个月的外周血中分别检测活化血小板糖蛋白GPⅡb/Ⅲa抗原决定簇、血小板活化标记物P-选择素、血小板-单核细胞聚集体及白细胞介素6的变化。 结果：26只家兔均进入结果分析。支架置入后0.5 h，6 d和1个月时血小板活化血小板糖蛋白GPⅡb/Ⅲa抗原决定簇、血小板活化标记物P-选择素和血小板-单核细胞聚集体较置入前即刻升高(P < 0.05)；白细胞介素6在支架置入后6 d，1个月和6个月时较置入前即刻升高(P < 0.05)。 结论：家兔颈动脉内支架置入后仍存在血小板活化与聚集，而白细胞介素6长期维持在高位水平可能与支架置入后血管内发生再狭窄密切相关。

Alterations of platelet activation and related factors following carotid artery stenting in rabbits

BACKGROUND: The role of inflammatory reaction and inflammatory factors and the mechanism of pathophysiology of restenosis following the stent implantation remains controversial. OBJECTIVE: To observe the changes of platelet activation markers and correlated factors following carotid artery stenting in rabbits. DESIGN, TIME AND SETTING: Observation experiment was performed at the Institute of Neurobiology of Henan University from March to September 2008. MATERIALS: A total of 26 rabbits, male or female, weighing 2.1-2.9 kg, were included. The alloy stent was made of 90% platinum and 10% iridium with wire diameter of 0.13 mm and monofilament winding spiral structure. The alloy stent was submerged 100 g/L gelatin solution, and made into protein-coated stent after dried. METHODS: Animals were anesthetized by sodium pentobarbital (30 mg/kg), and the right carotid artery was exposed. The stent was inserted in the proximal end after administration of aspirin and clopidogrel dual antiplatelet therapy. Penicillin was intravenously injected, 800 000 IU per day. MAIN OUTCOME MEASURES: The platelet-activating factor (PAC-1 and CD62P) of peripheral blood, platelet-monocyte aggregates and interleukin (IL-6) immediately before and 0.5 hour, 6 days, 1 month and 6 months after implantation were determined. RESULTS: Twenty-six rabbits were included in the final analysis. The level of PAC-1, CD62P and platelet-monocyte aggregates at 0.5 hour, 6 days and 1 month after inserting were significantly elevated compared with the levels immediately before inserting (P < 0.05). The level of IL-6 at 6 d, 1 and 6 months after inserting was significantly higher than the level immediately before inserting (P < 0.05). CONCLUSION: There still exists platelet activation and aggregation after stenting in the rabbit carotid artery, and the long-term maintenance of high level IL-6 may be related to the arterial restenosis.