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目的利用血管内超声观察冠状动脉钙化病变对药物洗脱支架植入后内膜增生的作用。方法对97例(99处病变)冠心病患者在药物洗脱支架植入后8个月利用血管内超声(IVUS)测定支架近端、支架远端和支架内管腔最小处血管段外弹力膜(EEM)横截面积(CSA),支架内CSA,管腔CSA,新生内膜面积,支架最大直径及最小直径,并推算支架对称指数。根据IVUS检测血管钙化的情况将支架植入段血管分为钙化病变组和非钙化病变组,观察钙化病变对支架植入后内膜增生的作用。结果99处病变中有14例支架内内膜增生。与非钙化组患者比较,钙化病变组支架植入后支架两端支架内CSA相似:支架近端为(7·30±1·94)mm2和(6·58±1·96)mm2;支架远端为(6·74±2·02)mm2和(6·14±1·82)mm2。但支架内最小CSA明显减小[(6·10±1·87)mm2和(4·97±1·51)mm2,P<0·05]且对称性较差(对称指数0·92±0·07和0·87±0·09,P<0·05),但内膜面积反而显著减少(0·53±1·50)mm2与(0·02±0·20)mm2。结论冠状动脉药物洗脱支架治疗钙化病变支架扩张程度和对称性均较差,但是与非钙化病变患者比较,内膜增生反而减少。
Objective To evaluate the effect of coronary artery calcification on endometrial hyperplasia after drug-eluting stent implantation by intravascular ultrasound. Methods Ninety-seven patients with coronary heart disease (99 lesions) underwent coronary angiography (IVUS) 8 months after the drug-eluting stents were implanted. The proximal end of the stent, the distal end of the stent and the stent- (EEM) cross-sectional area (CSA), stent CSA, lumen CSA, neointimal area, stent maximum diameter and minimum diameter, and calculate stent symmetry index. According to the IVUS detection of vascular calcification, the vessels of the stent implantation were divided into calcification group and non-calcification group, and the effect of calcification on intimal hyperplasia after stent implantation was observed. Results Of the 99 lesions, 14 had endometrial hyperplasia. Compared with non-calcified group, CSA in stents with calcified lesion group was similar after scaffold implantation: the proximal end of stent was (7.30 ± 1.94) mm2 and (6. 58 ± 1.96) mm2; The ends were (6 · 74 ± 2 · 02) mm2 and (6 · 14 ± 1 · 82) mm2. However, the minimal CSA in the stent decreased significantly [(6 · 10 ± 1.87) mm2 and (4.97 ± 1.51) mm2, P <0.05) with poor symmetry (symmetry index 0.92 ± 0 · 07 and 0 · 87 ± 0 · 09, P <0 · 05), but the intimal area decreased significantly (0 · 53 ± 1 · 50) mm2 and (0 · 02 ± 0 · 20) mm2. Conclusion Coronary artery drug-eluting stents have a poor degree of expansion and symmetry in calcification lesions, but neointimal hyperplasia is reduced compared with non-calcified lesions.