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目的:比较稳定型冠心病患者动脉血浆血小板活化因子(PAF)浓度在药物洗脱支架(DES)置入前、后的变化,探讨基线PAF水平与心血管事件的关系。方法:2007年8月至2008年12月,入选88例稳定冠心病患者,收集其临床、冠脉造影(CAG)和经皮冠脉介入治疗(PCI)资料。所有入选者均采用酶联免疫吸附法测定PCI前留取的动脉(主动脉根部)血浆PAF水平。根据基线PAF水平分层,随访1年时的死亡、非致死性急性冠脉综合征(ACS)、再次PCI、再次心血管原因入院等主要不良心血管事件。29例稳定冠心病患者在DES置入平均8个月后进行了CAG复查和PAF水平测定。结果:DES置入8个月后随访PAF浓度明显低于基线水平[(236.25±17.78)pg/ml∶(349.92±38.44)pg/ml,P=0.0109]。平均随访12.5月,PAF高水平(PAF≥260pg/ml)组死亡、非致死性ACS、再入院和再次PCI联合终点心血管事件较低水平(PAF<260pg/ml)组明显增多(RR=1.714,95%CI:1.051~2.796,P=0.031)。结论:稳定冠心病患者血小板活化因子水平与短期内主要不良心血管事件有关;药物洗脱支架置入8个月后血小板活化因子水平明显降低,可能与其有效地抑制了炎症反应和降低了血小板的激活有关。
Objective: To compare the changes of PAF in patients with stable coronary heart disease before and after drug-eluting stent (DES), and to explore the relationship between baseline PAF and cardiovascular events. Methods: From August 2007 to December 2008, 88 patients with stable coronary heart disease were enrolled and their clinical, coronary angiography (CAG) and percutaneous coronary intervention (PCI) data were collected. All participants were enrolled in this study to determine plasma levels of PAF in pre-PCI arteries (aortic roots) using enzyme-linked immunosorbent assay. Based on baseline PAF levels, major adverse cardiovascular events such as death at one year of follow-up, nonfatal acute coronary syndromes (ACS), PCI again, and subsequent hospital admission for cardiovascular causes were also performed. Twenty-nine patients with stable coronary artery disease underwent CAG and PAF levels after an average of 8 months of DES placement. Results: Follow-up PAF concentrations were significantly lower than those at baseline after DES for 8 months [(236.25 ± 17.78) pg / ml: (349.92 ± 38.44) pg / ml, P = 0.0109]. At a mean follow-up of 12.5 months, patients with high PAF levels (PAF ≥ 260 pg / ml), non-fatal ACS, rehospitalization and PCI at the lower end of the cardiovascular event (PAF <260 pg / ml) , 95% CI: 1.051-2.756, P = 0.031). Conclusion: The level of platelet-activating factor in patients with stable coronary heart disease is related to short-term major adverse cardiovascular events. The level of platelet activating factor is significantly decreased after 8 months of drug-eluting stent implantation, which may be related to its inhibition of inflammatory response and reduction of platelet Activation related.