持续炎症状态对冠状动脉支架内再狭窄的影响和预测分析  

Influence and predictive value of persistent inflammation state on in-stent restenosis following coronary stent implantation

作　　者：许海燕[1] 张家芬[1] 乔树宾[1] 李建军[1] 杨跃进[1] 徐波[1] 

机构地区：[1]中国医学科学院心血管病研究所阜外心血管病医院心内科,北京100037

出　　处：《中华老年心脑血管病杂志》2010年第10期870-872,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨PCI前后持续炎症状态对PCI后支架内再狭窄的影响和预测作用。方法选择成功行支架置入术并于3个月后至1年内复查冠状动脉造影的患者431例，分为支架内再狭窄组（再狭窄组）124例和无支架内再狭窄组（无再狭窄组）307例。患者于PCI前及复查冠状动脉造影时均检测C反应蛋白（CRP）、高敏CRP（hs-CRP）。结果与无再狭窄组比较，再狭窄组患者PCI前CRP和hs-CRP以及PCI后CRP均明显升高，差异有统计学意义（P〈0．05，P〈0．01）。将PCI前hs-CRP分为〉2mg／L和≤2mg／L2个等级，hs-CRP增高的患者支架内再狭窄的发生率明显升高（χ^2=5．03，P〈0．05）。logistic回归分析显示，hs-CRP高的患者发生支架内再狭窄的风险明显增加（OR=1．840，95％CI：1．076～3．157，P〈0．05）。结论PCI前后持续的炎症状态是发生支架内再狭窄的危险因素和预测指标，应积极加强抗炎以改善PCI后患者的临床预后。Objective To investigate the influence and predictive value of persistent inflammation state on the incidence of in-stent restenosis（ISR）. Methods 431 coronary artery disease（CAD） patients successfully underwent PCI with stent implantation. Follow up coronary angiography was performed at three months to one year after PCI and they were divided into the ISR group （n = 124） and the non-ISR group （n = 307） based on the presence or absence of ISR. Serum concentrations of C-reactive protein（CRP） and high-sensitivity CRP（hs-CRP） were determined before PCI and during re-evaluation. Results The levels of CRP and hs-CRP before PCI in ISR group were significantly higher than those in non-ISR group（CRP：median 3.41 mg/L and 2.86 mg/L,respectively, P 〈 0.05. hs-CRP：median 1.54 mg/L and 0. 89 mg/L,respectively, P 〈 0.05）. The CRP level at re-evaluation was higher in ISR group than in non-ISR group（median 1.85 mg/L and 1.14 mg/L,respectively, P 〈 0.05）. The incidence rate of ISR in patients with hs-CRP〉2 mg/L before PCI was higher than that in patients with hs-CRP〉2 mg/L （Z2 ： 5.03 ,P 〈 0.05）. Logistic regression showed that the risk of ISR markedly increased in patients with hs-CRP〉2 mg/L （OR ： 1. 840,95 % CI： 1. 076-3. 157, P 〈 0.05）. Conclusion Inflammation state before and after PCI increases the risk of ISR and can predict angiographic outcome after stent implantation. It is suggested that aggressive possible therapeutic measures should be taken to reduce inflammatory burden with the aim to improve clinical and angiographic outcome after PCI.

关 键 词：支架 血管成形术 经腔 经皮冠状动脉 炎症 冠状动脉疾病 冠状动脉再狭窄 预测 冠状血管造影术 

分 类 号：R543[医药卫生—心血管疾病]