紫杉醇与雷帕霉素复合药物涂层支架预防冠脉再狭窄动物实验研究  

Experimental study on the preventive effect of paclitaxel and rapamycin composite drug-eluting stent on coronary restenosis in minipigs

作　　者：王浩[1] 李泱[2] 张文辉 高伟[2] 栗竞 李晓英[2] 文毅[2] 徐占稳 苟鹏[4] 黄丽洁[4] 

机构地区：[1]中国人民解放军总医院南楼心血管二科,北京市100853 [2]中国人民解放军总医院老年心血管病研究所,北京市100853 [3]原子能科技股份有限公司 [4]中国人民解放军总医院医学实验动物中心,北京市100853

出　　处：《河北医药》2013年第2期173-175,共3页Hebei Medical Journal

摘　　要：目的观察运用纳米技术不同剂量紫杉醇与雷帕霉素复合药物涂层支架对预防支架内再狭窄的安全性及有效性。方法采用小型猪冠状动脉过度扩张的再狭窄模型,于右冠状动脉植入3种不同剂量组合的雷帕霉素和紫杉醇复合药物涂层支架:A支架,中剂量紫杉醇+低剂量雷帕霉素;B支架,中剂量紫杉醇+中剂量雷帕霉素;C支架,低剂量紫杉醇+高剂量雷帕霉素。比较6周后冠状动脉造影及组织病理学结果。两次造影术后抽血化验肝、肾功能。结果共在4头小型猪右冠状动脉内成功植入支架8枚,A支架4枚,B支架2枚,C支架2枚,术后即刻冠状动脉造影显示均通畅,6周后冠状动脉造影显示1枚A支架内狭窄,余均通畅。病理结果显示,与其他支架比较,狭窄支架新生内膜明显增生(P<0.05),管腔面积明显减少(P<0.05),余支架内膜增生不明显,无明显管腔狭窄。每头猪术前术后肝、肾功能无明显变化。结论中剂量紫杉醇+低剂量雷帕霉素涂层支架不能完全抑制6周血管内膜增生,中剂量紫杉醇+中剂量雷帕霉素及低剂量紫杉醇+高剂量雷帕霉素涂层支架可以有效抑制血管内膜增生、预防再狭窄,安全性好。Objective To observe the safety and effectivity of different doses of paclitaxel and rapamycin composite drug-eluting stent in preventing in-stent restenosis by means of nanotechnology in minipigs. Methods The animal models of coronary restenosis were established in minipigs by oversizing the stent. The three different doses of paclitaxel and rapamycin composite drug-eluting stents were randomly inserted into porcine right coronary .The stento were divided into three kinds including stent A： middle-dose paelitaxel with low-dos rapamyein,stent B： middle-dose paclitaxel with middle-dose rapamycin and stent C： low-dose paclitaxel withhigh-dose rapamycin. The examination results of coronary arteriongraphy and histopathology were observed and compared among the three kinds of stents after 6 weeks, and hepatic function and renal function of the minipigs were detected after twice angiography. Results The total eight stents including four stents A,two stents B and two stents C were successfully inserted into the right coronary arteries of 4 minipigs. The coronary angiogram immediately after stenting showed it was easy and smooth in every stent. 6 weeks after stenting, the coronary angiogram showed one stent A developed in-stent restenosis and the others were easy and smooth. The histopathological results showed that the neointima hyperplasia of restenosis stem was more obvious, and the lumen area of restenosis stent was obviously decreased, as compared with that in the other stents （ P 〈 0.05 ）. However the hepatic function and renal function of the minipigs were not obviously changed. Conclusion The stent eluted by middle-dose paclitaxel and low-dose rapamycin is insufficient for complete inhibition of neointima hyperplasia after 6 weeks, however, the other two kinds of stents can completely inhibit neointima hyperplasia and prevent restenosis,with good safety.

关 键 词：支架 复合药物涂层 再狭窄 雷帕霉素紫杉醇 

分 类 号：R543.3[医药卫生—心血管疾病]