冠状动脉支架术后再狭窄与妊娠相关蛋白A的关系  

Relationship between pregnancy-associated plasma protein A level and restenosis after elective coronary stenting

作　　者：李旭平[1] 周胜华[1] 唐建军[1] 刘启明[1] 方臻飞[1] 胡信群[1] 周滔[1] 

机构地区：[1]中南大学湘雅二医院心内科,长沙市410011

出　　处：《中华老年医学杂志》2008年第4期241-243,共3页Chinese Journal of Geriatrics

基　　金：湖南省自然科学基金（02JJY2043）

摘　　要：目的探讨冠状动脉粥样硬化性心脏病（冠心病）患者支架术后再狭窄与妊娠相关蛋白A（PAPP-A）的关系。方法选择冠状动脉内支架术6～12个月后进行复查的132例冠心病心绞痛患者为对象，其中前降支病变62例，回旋支36例，右冠状动脉34例，进行冠状动脉造影检查，以冠状动脉造影狭窄率≥50％为支架内再狭窄。测定PAPPA的浓度，将患者分为高PAPP-A组（PAPP-A≥12．11mIU／L）66例和低PAPP-A组（PAPP-A〈12．11mIU／L）66例，通过血管内超声波（IVUS）检查，观察两组冠状动脉支架术后新生内膜面积、新生内膜体积。结果132例冠状动脉造影示再狭窄42例（31．8％），再狭窄组和无再狭窄组患者年龄、性别、冠状动脉疾病危险因素比较，差异无统计学意义。再狭窄患者PAPP-A水平高于无再狭窄的患者，分别为（18．14±2．26）mIU／L与（10．95±2．12）mIU／L，差异有统计学意义（P〈0．01）。高PAPP-A组再狭窄率为42．4％（28例），低PAPP-A组为21．2％（14例），两组差异有统计学意义（P〈0．01）。相关分析显示，PAPP-A与新生斑块面积及体积呈正相关（r分别为0．47及0．54，P〈0．05）。结论PAPP-A与内膜增生有关，PAPP-A可能通过促进新生内膜增生而引起支架术后再狭窄。Objective To investigate the relationship between pregnancy-associated plasma protein A （PAPP-A） level and restenosis after elective coronary stenting by coronary artery angiography （CAG） and intravascular ultrasound （IVUS）. Methods The study consisted of 132 patients with successful coronary stent placement：left anterior descending coronary artery （LAD） 62, left circumflex coronary artery（LCX）36, right coronary artery （RCA） 34. The follow-up CAG and IVUS were performed at the 6th month after stent placement. Diameter stenosis ≥50% on CAG was regarded as in-stent restenosis. Neointimal areas（IA）, stent volume （SV） and neointimal volume （IV） were measured by IUVS during follow-up. According to the PAPP-A level, lesions were divided into 2 groups： high PAPP-A group（PAPP-A level≥12.11 mIU/L） and low PAPP-A group （PAPP-A level 〈 12.11 mIU/L）. Results Total restenosis rate was 31.8%. There were no significant differences in age, sex and risk factors of coronary heart disease （hypertension, diabetes, smoking） between restenotic and nonrestenotic groups （all P〉0.05）. The restenotic group had higher PAPP-A level than nonrestenotic group [（18.14 ± 2.26） mIU/L vs. （10.95 ± 2. 12） mIU/L, P〈 0.01] . Angiographic restenosis occurred in 28 of 66 lesions （42.4%） in the high PAPP-A group and in 14 of 66 lesions （21.2%） in the low PAPP-A group （P〈0. 01）. Plasma PAPP-A level was positively correlated with IA, IV （r = 0. 47 and 0.54 respectively, all P〈 0.05）. Conelusions Elevated PAPP-A level is correlated well with the severity of the intimal hyperplasia. Plasma PAPP-A level affects restenosis after elective stent placement by promoting intimal hyperplasia.

关 键 词：妊娠蛋白质类 冠状动脉再狭窄 支架 超声检查 介入性 

分 类 号：R686[医药卫生—骨科学]