血浆P-选择素和内皮素-1预测冠状动脉内支架术后早期再狭窄的价值  

The study on prognostic value of plasma endothelin 1 and P-selectin in early in-stent restenosis

作　　者：苏子德[1] 代怀静[1] 王涛[1] 刘跃森[1] 侯子龙[1] 蔡庆岭[1] 

机构地区：[1]聊城市第二人民医院心内科,山东临清252601

出　　处：《中国介入心脏病学杂志》2006年第4期222-225,共4页Chinese Journal of Interventional Cardiology

基　　金：山东省卫生厅科研基金资助(2003HW019)

摘　　要：目的 探讨急性冠状动脉综合征（ACS）患者经皮介入治疗（PCI）术后血浆P-选择素及内皮素-1（ET-1）的动态变化对预测术后发生支架内再狭窄的价值.方法 对108例行PCI手术的ACS患者,分别于术前和术后即刻、1周、2周、1个月、3个月、6个月采集外周静脉血,4℃离心分离血浆,-70℃保存备测.所有患者术后6个月常规行冠状动脉（冠脉）造影（CAG）.根据冠脉造影结果 分为冠脉再狭窄组和无再狭窄组,并分析两组血浆P-选择素及ET-1的水平.结果 随访中4例患者死亡,均为急诊PCI患者,4例失访,余100例根据冠脉造影结果 分为冠脉再狭窄组（n=16）和无再狭窄组（n=84）.两组ACS患者血浆 P-选择素及ET-1在术后即刻达高峰,较术前明显增加,冠脉无再狭窄组术后24 h恢复至术前水平,2周降至正常,术后1个月、3个月、6个月在正常基线范围内上、下波动.冠脉再狭窄组血浆P-选择素和ET-1术后2周没有降至正常,而呈持续性升高,并在术后3～6个月出现第2次高峰,与无再狭窄组相比差异有统计学意义.结论 ACS患者PCI术后早期（1～2周）P-选择素及ET-1持续升高,并在术后3～6个月出现第2次高峰,则冠脉发生再狭窄的危险性高.P-选择素及ET-1可作为预测早期冠脉再狭窄的参考指标.Objective To study the changes and its clinical prognostic value of plasma endothelin 1 （ET- 1 ） and P-selectin on early in-stent restenosis after percutanous intervention （PCI） in patients with acute coronary syndrome （ACS）. Methods Venous blood samples were drawn from a total of 108 patients who underwent PCI before and right after the operation, as well as at 1 week, 2 weeks, 1 month, 3 months and 6 months postprocedure. Plasma was separated immediately by centrifugation at 4℃ and stored at - 70℃ until detection. All patients received coronary angiography after six months and were catagorized into the restenosis and non-restenosis group according to the result. Plasma levels of ET-1 and P-selectin of the two groups were analyzed. Results Four cases received acute PCI died and another 4 cases lost follow-up. The remaining cases were divided into the restenosis （n = 16） and non-restenosis （n = 84） group according to their coronary angiography result. Plasma levels of ET-1 and P-selectin reached the peak concentration in the two groups right after PCI. In the non- restenosis group, plasma levels of ET-1 and P-selectin resumed to pre-opeation level at 24 hours and resumed to normal level at 2 weeks. In the restenosis group, plasma levels of ET-1 and P-selectin did not resume to normal level at 2 weeks but increased persistently, and showed their second peak value at 3 - 6 months after PCI. Conclusion The risk of restenosis increased accompanied by the persistent increase of plasma levels of ET-1 and P-selectin in early stages （1 - 2 weeks） after PCI in ACS patients. ET-1 and P-selectin may be regarded as makers for early recognition of restenosis.

关 键 词：冠状动脉疾病 血管成形术 经腔 经皮冠状动脉 支架 内皮缩血管肽-1 P选择素 

分 类 号：R259.434[医药卫生—中西医结合]