可降解金属血管支架的研发进展  

Progress in research and development of biodegradable metallic vascular stents

作　　者：杨炎 张针锋 王俊伟 傅柯芸 李东阳 何昊[1,2] 舒畅[1,2,3] YANG Yan;ZHANG Zhenfeng;WANG Junwei;FU Keyun;LI Dongyang;HE Hao;SHU Chang(Department of Vascular Surgery,Second Xiangya Hospital,Central South University,Changsha 410011;Vascular Disease Institute,Central South University,Changsha 410011;Department of Vascular Surgery,Fuwai Hospital,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]中南大学湘雅二医院血管外科,长沙410011 [2]中南大学血管病研究所,长沙410011 [3]中国医学科学院阜外医院血管外科,北京100037

出　　处：《中南大学学报(医学版)》2024年第11期1861-1868,共8页Journal of Central South University :Medical Science

基　　金：湖南省自然科学基金(2022JJ80038);长沙市重大科技项目(kq2207010)。

摘　　要：血管支架作为心血管介入治疗的重要手段,随着心血管疾病发病率的增加,其需求越来越大。相比于永久性支架易导致血管再狭窄、药物洗脱支架引起迟发性支架内血栓,可降解支架在完成早期为血管提供径向支撑,避免血管弹性回缩的使命后开始降解,从而使血管恢复正常的生理收缩和积极重塑。回顾目前主流可降解金属(镁基合金、铁基合金、锌基合金)支架的临床前研究和临床研究的主要结果发现,镁基合金支架可操作性良好,血栓形成率较低,存在的问题主要在降解速率快、释氢反应和微环境pH值变化较大等方面;铁基合金支架力学性能、成型加工性、生物相容性和血液相容性优异,但其腐蚀速率过慢,提高降解速率是扩大铁基金属支架临床应用的关键;锌基合金的降解速率适中,强度较低,加入不同合金元素改善锌基合金支架强度是目前锌基合金支架的主要改良方向。可降解金属支架材料的革新和突破需要材料学、生物学、化学、医学等多学科共同合作,除此以外,优化材料性能,以及改进制作工艺如注射成型技术、可降解药涂支架、纳米载药技术等可能是未来可降解金属支架的发展方向。Vascular stents are an essential tool in cardiovascular interventional therapy,and their demand is growing with the increasing incidence of cardiovascular diseases.Compared with permanent stents,which are prone to in-stent restenosis,and drug-eluting stents,which may cause late stent thrombosis,biodegradable stents offer advantages.After providing early radial support to prevent elastic recoil,biodegradable stents gradually degrade,allowing the vessel to regain its natural physiological contractility and undergo positive remodeling.A review of the current mainstream biodegradable metal stents,magnesium-based,iron-based,and zinc-based alloys,shows promising findings in both preclinical and clinical research.Magnesium-based stents exhibit good operability and low thrombosis rates,but their limitations include rapid degradation,hydrogen evolution,and significant pH changes in the microenvironment.Iron-based stents demonstrate excellent mechanical strength,formability,biocompatibility,and hemocompatibility,but their slow corrosion rate hampers broader clinical application;accelerating degradation remains key.Zinc-based alloys have a moderate degradation rate but relatively low mechanical strength;enhancing stent strength by alloying with other elements is the main improvement direction for zinc-based stents.

关 键 词：生物可降解支架 血管支架 金属支架 生物相容性 机械性能 

分 类 号：R318.08[医药卫生—生物医学工程]