药物洗脱支架后支架内再狭窄因素的探讨及sPLA2、hs-CRP的预测价值  

Factors for in-stent restenosis after DES and the predictive value of sPLA2 and hs-CRP in patients with coronary heart disease

作　　者：毛艳阳[1,2] 王军强 刘晓唤[2] 牛晓婷 周静 巩红[2] 马维冬[2] 姚智会 范雅洁 陈继舜 王聪霞 MAO Yan-yang;WANG Jun-qiang;LIU Xiao-huan;NIU Xiao-ting;ZHOU Jing;GONG Hong;MA Wei-dong;YAO Zhi-hui;FAN Ya-jie;CHEN Ji-shun;WANG Cong-xia(Department of Cardiology,the Affiliated Hospital of Yan an University,Yan an 716000;Department of Cardiology,the Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004;Department of Cardiology,Tang Cheng Hospital Xi’an,Xi’an 710016;Dongfeng General Hospital,the Affiliated Hospital of Hubei University of Medicine,Shiyan 442008,China)

机构地区：[1]延安大学附属医院心内科,陕西延安716000 [2]西安交通大学第二附属医院心内科,陕西西安710004 [3]西安市唐城医院心血管内科,陕西西安710016 [4]湖北医药学院附属东风总医院,湖北十堰442008

出　　处：《西安交通大学学报（医学版）》2018年第3期341-343,348,共4页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家自然科学基金资助项目(No.81273878)~~

摘　　要：目的探讨药物洗脱支架(DES)后1年时支架内再狭窄的影响因素及血清分泌型磷脂酶A2(sPLA2)和高敏C反应蛋白(hs-CRP)的预测价值。方法选取2014年1月至2016年1月于延安大学附属医院行DES植入的120例患者,根据1年时是否出现再狭窄分为再狭窄组(ISR组)及无再狭窄组(non-ISR组);评估两组一般临床资料及支架植入前后sPLA2、hs-CRP水平;采用Logistic回归分析1年支架内再狭窄的影响因素。结果 ISR组完全闭塞病变率(31.43%vs.17.65%)、支架重建率(31.43%vs.16.47%)、后扩张发生率(35.29%vs.11.43%)显著高于nonISR组(P<0.05);ISR组支架植入前后hs-CRP及sPLA2水平均显著高于non-ISR组(P<0.05),且植入支架后ISR组及non-ISR组hs-CRP及sPLA2水平均显著升高(P<0.05);1年支架内再狭窄的发生与完全闭塞病变、后扩张、hs-CRP及sPLA2显著相关(P<0.05)。结论完全闭塞病变、后扩张、hs-CRP及sPLA2可能是DES后1年内支架内再狭窄的独立危险因素。血清sPLA2、hs-CRP可能对支架内再狭窄有重要的预测价值。Objective To investigate the risk factors for in-stent restenosis(ISR)within one year after drug eluting stent(DES)intervention and the predictive value of secretory phospholipase A2(sPLA2)and high sensitivity c-reactive protein(hs-CRP)in patients with coronary heart disease after percutaneous coronary intervention(PCI).Methods From January 2014 to January 2016,the 120 patients who received DES in the Affiliated Hospital of Yan an University were divided into ISR group and non-ISR group according to the results of coronary angiography.We evaluated the general clinical data and serum sPLA2 and hs-CRP levels before and after PCI.Then we used multivariate logistic regression analysis to find the independence risk factors for ISR within one year.Results The occlusion lesions(31.43%vs.17.65%)and stent reconstruction(31.43%vs.16.47%)in ISR group were significantly higher than those in non-ISR group(P<0.05).The rate of post-ballooning of stents was higher(11.43%vs.35.29%,P<0.05)in non-ISR group than that in ISR group.The hs-CRP and sPLA2 concentrations in ISR group were significantly higher than those in non-ISR group(P<0.05)before and after PCI and they were obviously increased after PCI in both groups(P<0.05).We also found that ISR was correlated with hs-CRP,sPLA2,occlusion lesions,and post-ballooning of stents(P<0.05).Conclusion The occlusion lesions,post-ballooning of stent,hs-CRP and sPLA2 may be the independence risk factors for ISR within one year.Serum sPLA2 and hs-CRP have the predictive value for ISR after DES implantation in patients with coronary heart disease.

关 键 词：冠心病 药物洗脱支架 SPLA2 HS-CRP 支架内再狭窄 

分 类 号：R541.4[医药卫生—心血管疾病]