紫杉醇药物支架对血管内皮功能的影响

目的：研究紫杉醇药物支架对血管内皮功能的影响。方法：2006年7月至2006年12月于南京市心血管病医院入选72例冠脉造影患者,48例患者行冠脉内单支架置入术,随机分为紫杉醇药物支架组（PES组）和金属裸支架组（BMS组）各24例,24例冠脉造影正常者为正常对照组。采用高分辨率彩色多普勒超声仪测量患者术后1d、术后6个月的内皮依赖性血流介导的血管扩张（FMD）与非内皮依赖性硝酸甘油介导的血管扩张（NMD）。冠脉支架置入患者,通过冠脉内灌注乙酰胆碱（Ach）、硝酸甘油,利用定量冠状动脉造影（QCA）测量术后即刻、术后6个月内皮依赖性的血管扩张反应与非内皮依赖性的血管扩张反应。结果：术后6个月经皮冠脉内支架置入（PCI）病人中FMD明显低于正常对照组（5.7%±3.2%vs11.4%±4.2%,P〈0.01）,NMD两组无差别（P〉0.05）。PES组术后6个月FMD明显低于术后1d（4.6%±2.3%vs8.7±2.9%,P〈0.05）,BMS组术后6个月与术后1dFMD无差别（7.8%±3.4%vs8.5%±4.6%,P〉0.05）。术后6个月PES组FMD功能低于BMS组（4.6%±2.3%vs7.8±3.4%,P〈0.01）,NMD两组无明显差别（P〉0.05）。PES组术后6个月Ach灌注激发的内皮依赖性的血管扩张反应低于术后即刻（-32%±3%vs-8%±2%,P〈0.01）,BMS组术后6个月Ach灌注激发的内皮依赖性的血管扩张反应与术后即刻无明显差别（-6%±3%vs-4%±2%,P〉0.05）。术后6个月PES组Ach灌注激发的内皮依赖性的血管扩张反应低于BMS组（-32%±3%vs-6%±3%,P〈0.01）,两组非内皮依赖性的血管扩张反应无差别（P〉0.05）。结论：紫杉醇药物支架置入后6个月冠脉血管内皮功能发生障碍。

Effects of Paclitaxel-eluting stent on blood vessel endothelial function

AIM： To investigate the effects of Paclitaxel-eluting stent on blood vessel endothelial function. METHODS： From July to December in 2006, 72 patients with coronary arteriongraphy of Nanjing Angiocardiopathy Hospital were selected into the clinical study, 48 patients who accepted percutaneous coronary intervene（PCI） in coronary artery were randomly divided into Paclitaxel-eluting stent （PES） Group and Bare metal stent （BMS） Group, 24 patients each group, the other 24 normal patients were assigned into Control Group. The endothelium-dependent flow mediated dilation（FMD） and endothelium-independent nitroglycerinmediated dilation （NMD） of brachial artery 1 day and 6 months after operation were assessed by high-resolution color Doppler ultrosound. The endothelium-dependent vasomotion and endothelium-independent vasomotion of a coronary segment were assessed with quantitative coronary angiography （QCA） immediately after the operation and at 6 months follow-up, after intracoronary infusion of acetylcholine and nitroglycerin. RESULTS： 6 months after the operation, compared with Control patients with PCI had lower FMD （5.7% ± 3.2% vs 11.4% ±4.2%, P 〈0.001）, but NMD did not significantly differ between groups（P 〉 0.05）. For PES Group, FMD of the first day after operation and at the follow-up 6 months were 8.7% ± 2.9% vs 4.6% ±2.3% （P 〈0.05）, while BMS Group, FMD of the first day after operation and at the follow-up 6 months had no significant difference（ P 〉 0.05）. Compared with BMS group, PES group had lower FMD at the follow-up 6months （4.6% ± 2.3% vs 7.8% ± 3.4%, P 〈 0.001）, but NMD had no significant difference between groups （ P 〉 0.05）. For PES Group, the endothelium-dependent vasomotion （ intr-aeoronary infusion of aeetyleholine） of immediately after the operation and at the follow-up 6 months were - 8% ± 2% vs - 32% ± 3% （ P 〈 0.001）, while BMS Group, the endothelium-dependent vasomotion of the first day after operation and at the f