雷帕霉素-替罗非班复合药物涂层支架预防支架内血栓和再狭窄的实验研究  

Experimental study of stent-based delivery of rapamycin and tirofiban on preventing in-stent thrombosis and restenosis

作　　者：刁繁荣[1] 吕安林[1] 李军杰[1] 宋延彬[1] 温俊娜[1] 孟晓雪[1] 

机构地区：[1]第四军医大学西京医院心血管内科,陕西西安710032

出　　处：《心脏杂志》2007年第4期384-387,共4页Chinese Heart Journal

摘　　要：目的探讨雷帕霉素-替罗非班复合药物涂层支架预防支架内血栓和再狭窄的疗效及机制。方法8只小型猪随机分为单纯雷帕霉素涂层支架(RES)组和雷帕霉素-替罗非班复合药物涂层支架(RTES)组,每只动物于冠状动脉中置入支架2枚。术后RES组服用阿司匹林300 mg/d和氯吡格雷75 mg/d,3个月;RTES组服用阿司匹林300 mg/d,3个月,氯吡格雷75 mg/d,1个月。实验期间对动物行为学和出凝血障碍等并发症进行观察。3月后复查冠状动脉造影,处死动物,取出支架血管段,行组织病理学分析。结果①两组均未发现急性、亚急性和远期血栓,无出凝血等并发症发生。②支架部位血管腔面积:雷帕霉素涂层支架组为(4.89±0.46)mm2,雷帕霉素-替罗非班复合涂层支架组为(4.96±0.35)mm2;新生内膜面积:雷帕霉素涂层支架组为(1.05±0.09)mm2,雷帕霉素-替罗非班复合涂层支架组为(1.12±0.10)mm2;管腔面积丢失率:雷帕霉素涂层支架组为(21±7)%,雷帕霉素-替罗非班复合药物涂层支架组为(19±9)%。结论①雷帕霉素-替罗非班复合药物涂层支架可有效预防PC I术后支架内血栓形成。②雷帕霉素-替罗非班复合药物涂层支架防治支架内再狭窄的疗效与单纯雷帕霉素支架无差异。AIM To investigate the efficacy and the mechanism of stent-based rapamycin and tirofiban in combination （RTES） to prevent in-stent thrombosis and restenosis. METHODS 8 miniature pigs were randomly divided into experimental group and control group. Stents with rapamycin-tirofiban and polymer were implanted in the coronary arteries of pigs in the experimental group, while stents with rapamycin and polymer were implanted into the coronary arteries of pigs in the control group. Animals receiving RTES were treated with clopidogrel in a dose of 75 mg/d orally for 1 month after stent implantation, while Animals receiving RES in control group were treated orally with clopidogrel （75 mg/d） for three months. All animals were administered orally aspirin （300 mg/d） for 3 months. Coronary arteriographies were taken before, immediately after stents wrere implanted and before the pigs were sacrificed. Indexes of ethology and complication of hemorrhage were determined. Three momths later, arteries were compared in angiog- raphy, histopathology and histomorphometry analysis. RESULTS （1）Acute , subacute or later stent thrombosis weren＇t observed in both groups, as well as complications of hemorrhage and blood coagulation. （2）The lumen areas of the experimental group were similar with those of the control group [ （4.96 ± 0.35 ） vs （4.89 ± 0.46） mm^2 ]. The neointlmal areas in the experimental group were similar with those in the control group [ （1.12 ±0.10） vs （1.05 ±0.09）mm^2]. Both type of stents had similar effect on lumen stenosis rates （19% ±9% vs 21% ±7% ）. The side effects were not found in experiment animals. CONCLUSION （1）The rapamycin tirofiban eluting stent can prevent in-stent thrombosis effectively after PCI. （2）The efficacy of the rapamycin tirofiban eluting stent in preventing in-stent restenosis is not significantly different with the rapamycin eluting stent.

关 键 词：支架 再狭窄 雷帕霉素 替罗非班 

分 类 号：R541.4[医药卫生—心血管疾病]