中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (38): 7213-7216.doi: 10.3969/j.issn.1673-8225.2010.38.045

• 生物材料临床实践 clinical practice of biomaterials • 上一篇    下一篇

冠状动脉内药物洗脱支架或金属裸支架置入对患者血小板功能的影响

严  华，符春晖   

  1. 钦州市第二人民医院心内科，广西壮族自治区钦州市   535000
  • 出版日期:2010-09-17 发布日期:2010-09-17
  • 作者简介:严华★，男，1969年生，重庆市人，汉族，2003年新疆医科大学毕业，硕士，副主任医师，主要从事冠心病、高血压病的诊治研究。 yanhua.23@263.net

Effects of coronary drug-eluting stents or bare metal stent implantation on platelet function in patients

Yan Hua, Fu Chun-hui   

  1. Department of Cardiology, Qinzhou Second People’s Hospital, Qinzhou   535000, Guangxi Zhuang Autonomous Region, China
  • Online:2010-09-17 Published:2010-09-17
  • About author:Yan Hua★, Master, Associate chief physician, Department of Cardiology, Qinzhou Second People’s Hospital, Qinzhou 535000, Guangxi Zhuang Autonomous Region, China yanhua.23@263.net

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479

被引次数

5

摘要：

背景：冠状动脉内置入药物洗脱支架可以显著降低冠状动脉介入治疗后再狭窄的发生率和主要心血管不良事件，提高患者的生活质量，在临床得到了广泛应用。但近期的多项荟萃分析说明，与金属裸支架相比，药物洗脱支架显著增加晚期支架血栓形成，增加全因性死亡率。
目的：观察冠状动脉支架置入前、后和随访6个月血小板膜糖蛋白的变化，对比分析短、中期内置入药物洗脱支架或金属裸支架对血小板活化影响的差异。
方法：对2007-06/2009-06因急性冠脉综合征成功进行冠状动脉内支架置入治疗的104例患者进行回顾性分析，其中使用药物洗脱支架68例，金属裸支架36例。同时纳入34例因疑诊急性冠脉综合征而进行造影，证实血管完全正常的患者为对照组。比较各组患者外周血中CD62p，CD63和凝血酶敏感蛋白的阳性表达率。
结果与结论：在相同抗血小板治疗6个月时，与金属裸支架组相比，药物洗脱支架置入对患者血小板活化的影响仍较明显，这可能与药物洗脱支架的晚期支架血栓形成增加有关。目前所提倡的12个月的标准抗凝治疗是否足够，以及血小板活化功能检测对支架置入治疗后抗血小板治疗的临床指导意义等仍需进一步研究。

关键词: 冠状动脉, 支架置入, 急性心肌梗死, 血小板活化, 凝血敏感蛋白

Abstract:

BACKGROUND: Coronary drug-eluting stent implantation can significantly reduce restenosis after coronary intervention and major cardiovascular adverse events, improve patient’s quality of life, is widely used in clinical practice. However, a number of recent meta-analysis shows that compared with bare metal stents, drug-eluting stent significantly increased late stent thrombosis and all-cause death rate.
OBJECTIVE: To observe changes in platelet membrane glycoprotein before and after coronary artery stenting, as well as in follow-up 6 months, to compare the difference of short-term versus medium-term implanted drug-eluting stents or bare metal stents on the platelet activation.
METHODS: A total of 104 patients who were successfully treated with coronary stenting due to acute coronary syndrome between June 2007 and June 2009 were analyzed retrospectively, including 68 cases by use of drug-eluting stents, and 36 cases by use of bare metal stents. Meanwhile 34 patients with suspected acute coronary syndrome were included for the angiography, the patients confirmed as completely normal blood vessels served as the control group. The CD62p, CD63 and thrombin-sensitive protein expression rate in peripheral blood of patients was compared.
RESULTS AND CONCLUSION: Given the same anti-platelet therapy for 6 months, compared with bare metal stents, the influence of drug-eluting stent implantation on platelet activation was still evident, which may be associated with the increase of late stent thrombosis of drug-eluting stent. Further study should verify whether standard 12-month anticoagulant treatment, which is currently advocated, is adequate, and investigate clinical significance of the detection of platelet activation on antiplatelet therapy after stenting.

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