紫杉醇药物支架对血管内皮功能的影响

中国临床药理学与治疗学 ›› 2008, Vol. 13 ›› Issue (5): 563-568.

紫杉醇药物支架对血管内皮功能的影响

葛震, 陈绍良, 刘志忠, 张俊杰, 陈亮, 张娟, 李玉巧

南京医科大学附属南京第一医院心内科, 南京210006, 江苏

收稿日期:2007-11-26 修回日期:2008-04-07 发布日期:2020-11-09
通讯作者: 陈绍良, 男, 医学博士, 主任医师, 教授, 博导, 主要从事冠心病诊断与治疗研究。Tel:025-52271350 E-mail:chmengx @126.com
作者简介:葛震, 男, 主治医师, 医学硕士, 主要从事冠心病诊断与治疗研究。Tel:13770825567 E-mail:gezhen666 @163. com

Effects of Paclitaxel-eluting stent on blood vessel endothelial function

GE Zhen, CHEN Shao-liang, LIU Zhi-zhong, ZHANG Jun-jie, CHEN Liang, ZHANG Juan, LI Yuqiao

Department of Cardiology, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing 210006, Jiangsu, China

Received:2007-11-26 Revised:2008-04-07 Published:2020-11-09

摘要/Abstract

摘要： 目的:研究紫杉醇药物支架对血管内皮功能的影响。方法:2006 年7 月至2006 年12 月于南京市心血管病医院入选72 例冠脉造影患者, 48例患者行冠脉内单支架置入术, 随机分为紫杉醇药物支架组(PES 组) 和金属裸支架组(BMS 组) 各24 例, 24 例冠脉造影正常者为正常对照组。采用高分辨率彩色多普勒超声仪测量患者术后1 d、术后6 个月的内皮依赖性血流介导的血管扩张(FMD) 与非内皮依赖性硝酸甘油介导的血管扩张(NMD) 。冠脉支架置入患者, 通过冠脉内灌注乙酰胆碱(Ach)、硝酸甘油, 利用定量冠状动脉造影(QCA) 测量术后即刻、术后6 个月内皮依赖性的血管扩张反应与非内皮依赖性的血管扩张反应。 结果:术后6 个月经皮冠脉内支架置入(PCI) 病人中FMD 明显低于正常对照组(5. 7% ±3. 2% vs 11. 4% ±4. 2%, P <0. 01), NMD 两组无差别(P >0. 05) 。PES 组术后6 个月FMD 明显低于术后1 d(4. 6% ±2. 3% vs 8. 7 ±2. 9%, P <0. 05), BMS 组术后6 个月与术后1 d FMD 无差别(7. 8% ± 3. 4% vs 8. 5% ±4. 6%, P >0. 05) 。术后6 个月PES 组FMD 功能低于BMS 组(4. 6% ±2. 3% vs 7. 8 ±3. 4%, P <0. 01), NMD 两组无明显差别(P >0. 05) 。PES 组术后6 个月Ach 灌注激发的内皮依赖性的血管扩张反应低于术后即刻(-32% ±3% vs-8% ±2%, P <0. 01), BMS 组术后6 个月Ach 灌注激发的内皮依赖性的血管扩张反应与术后即刻无明显差别(-6% ±3% vs-4% ± 2%, P >0. 05) 。术后6 个月PES 组Ach 灌注激发的内皮依赖性的血管扩张反应低于BMS 组(- 32% ±3% vs-6% ±3%, P <0. 01), 两组非内皮依赖性的血管扩张反应无差别(P >0. 05) 。结论:紫杉醇药物支架置入后6 个月冠脉血管内皮功能发生障碍。

关键词: 紫杉醇药物支架, 金属裸支架, 血管内皮功能障碍, 内皮依赖性血管舒张, 非内皮依赖性血管舒张

Abstract: AIM:To investigate the effects of Paclitaxel- eluting stent on blood vessel endothelial function. METHODS:From July to December in 2006, 72 patients with coronary arteriongraphy of Nanjing Angiocardiopathy Hospital were selected into the clinical study, 48 patients who accepted percutaneous coronary intervene(PCI) in coronary artery were randomly divided into Paclitaxel-eluting stent (PES) Group and Bare metal stent (BMS) Group, 24 patients each group, the other 24 normal patients were assigned into Control Group. The endothelium-dependent flow mediated dilation(FMD) and endothelium-independent nitroglycerinmediated dilation (NMD) of brachial artery 1 day and 6 months after operation were assessed by high-resolution color Doppler ultrosound. The endothelium-dependent vasomotion and endothelium-independent vasomotion of a coronary segment were assessed with quantitative coronary angiography (QCA) immediately after the operation and at 6months follow-up, after intracoronary infusion of acetylcholine and nitroglycerin. RESULTS: 6 months after the operation, compared with Control patients with PCI had lower FMD (5. 7% ± 3. 2% vs 11. 4% ±4. 2%, P <0. 001), but NMD did not significantly differ between groups(P >0. 05). For PES Group, FMD of the first day after operation and at the follow-up 6 months were 8. 7% ±2. 9% vs 4. 6% ±2. 3% (P <0. 05), while BMS Group, FMD of the first day after operation and at the follow-up 6 months had no significant difference(P >0. 05). Compared with BMS group, PES group had lower FMD at the follow-up 6 months (4. 6% ±2. 3% vs 7. 8% ± 3. 4%, P <0. 001), but NMD had no significant difference between groups (P >0. 05). For PES Group, the endothelium-dependent vasomotion (intr-acoronary infusion of acetylcholine) of immediately after the operation and at the follow-up 6 months were-8% ±2% vs-32% ±3% (P <0. 001), while BMS Group, the endothelium-dependent vasomotion of the first day after operation and at the follow-up 6 months did not differ significantly(P >0. 05). Compared with BMS Group, PES Group had lower endothelium-dependent vasomotion(intracoronary infusion of acetylcholine) at the follow- up 6 months(-32% ±3% vs-6% ±3%, P < 0. 001), but there were not significant difference in endothelium- independent vasomotion (P > 0. 05). CONCLUSION:The blood vessel endothelial function was impaired at 6 months after Paclitaxel-eluting stent implantation.

Key words: Paclitaxel-eluting stent, bare metal stent, blood vessel endothelial dysfunction, endothelium- dependent vasomotion, endothelium-independent vasomotion

中图分类号:

葛震, 陈绍良, 刘志忠, 张俊杰, 陈亮, 张娟, 李玉巧. 紫杉醇药物支架对血管内皮功能的影响[J]. 中国临床药理学与治疗学, 2008, 13(5): 563-568.

GE Zhen, CHEN Shao-liang, LIU Zhi-zhong, ZHANG Jun-jie, CHEN Liang, ZHANG Juan, LI Yuqiao. Effects of Paclitaxel-eluting stent on blood vessel endothelial function[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2008, 13(5): 563-568.

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