冠心病支架内再狭窄患者血浆脂联素水平的观察

目的 观察冠心病患者支架置入术后再狭窄与血浆脂联素水平之间的关系.方法 对65例支架置入术后9～12个月无支架内再狭窄(A组)和54例存在支架内再狭窄≥50%(B组)的冠心病患者进行研究,复查冠状动脉造影当天取空腹12 h以上的股动脉血,采用ELISA法测定血浆脂联素水平;同时对支架置入前、置入术后即刻及9～12个月后的冠状动脉造影结果进行QCA评价.结果 A、B两组的靶血管病变部位及病变的复杂程度均相似,使用金属裸支架分别为8例(12.31%)和6例(11.11%);使用紫杉醇药物洗脱支架分别为11例(16.92%)和10例(18.52%);使用雷帕霉素药物洗脱支架分别为46例(70.77%)和38例(70.37%),术后用药两组之间无明显差异.A组脂联素水平明显高于B组(15.16±5.02)mg/L比(10.01±4.93)ms/L,P<0.05];两组的病变长度相似(15.82±6.67)mm比(13.40±4.20)mm,P>0.05];术前及术后即刻的最小管腔直径(MLD)、狭窄程度两组差异无统计学意义(P>0.05),但9～12个月时的QCA显示:A组的MLD为(2.55±0.53)mm,平均狭窄程度为(24.21±11.23)%,B组的MLD为(0.57±0.60)mm,平均狭窄程度为(81.00±19.11)%,P<0.01;即刻获得的管腔直径两组间比较无统计学意义(1.48±0.65)mm 比(1.19±0.37)mm,P>0.05];A组的晚期丢失明显小于B组(0.50±0.34)mm比(1.60±0.54)mm,P<0.01].结论 血浆脂联素水平降低可能是支架术后再狭窄的原因之一.

Association between plasma adiponectin level and in-stent restenosis after coronary stenting

Objective The purpose of the present study was to identify the relationship between the plasma level of adiponectin and in-stent restenosis of patients with coronary heart disease after coronary stenting. Method The study population comprised 119 individuals (92 men ) who underwent stent implantation, including 65 subjects without in-stent restenosis (group A ) and 54 patients with in-stent restenosis (group B). The level of plasma adiponectin was measured using ELISA. Coronary angiography was performed immediately before and after implanting stent and 9-12 months later. Results Baseline characteristics including drug use after PCI were similar between the groups. The rate of implanting bare metal stent is 8(12. 31% ) and 6(11.11% ), TAXUS drug-eluting stent is 11 (16. 92% ) and 10(18.52%) and CYPHER drug-eluting stent is 46 ( 70. 77% ) and 38 ( 70. 37% ) respectively ( all P > 0. 05 ). Plasma level of adiponectin in patient of group A was significantly higher than that in group B ( 15. 16±5.02 )mg/L vs. ( 10. 01±4. 93 ) mg/L, P < 0. 05 ]. The quantitative coronary angiography ( QCA ) showed that lesion length was similar between groups ( 15.82±: 6. 67 ) mm vs. ( 13.40±4. 20 )mm, P > 0. 05 ], minimum lumen diameter(MLD) and stenosis rate were also similar before and after implanting stent ( P > 0. 05 ) and acute gain was ( 1.48±0. 65 ) mm vs. ( 1.19±0. 37 ) mm ( P > 0. 05 ). MLD was higher in group A than that in group B (2.55±0.53)mm vs. (0.57±0.60)mm, P<0.01] at 9-12 months follow up. Restenosis rate (24.2±11.2)% vs. (81.0±19.1)%,P<0.01] and late lumen loss (0.50±0.34)mm vs.( 1.60± 0. 54)mm, P < 0. 01 ] were lower in group A than in group B. Conclusions The lower plasma adiponectin level might be associated with in-stent restenosis after coronary stenting.