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目的探讨小型猪冠状动脉支架置入术后血管壁炎症反应与新生内膜增生的关系。方法20只健康小型猪随机分入A组(L316不锈钢裸金属支架组)、B组(605L钴铬合金裸金属支架组)、C组(PLGA涂层605L支架组)和D组(PLGA涂层605L雷帕霉素洗脱支架组)。对每只猪于左前降支和右冠状动脉各置入同种支架1枚,至4周时取支架段冠状动脉切片、染色、镜检,测量冠状动脉壁炎症面积与新生内膜面积,分析其相关性。结果A、B、C、D组新生内膜面积分别为(2.09±0.90)、(2.11±1.07)、(1.42±0.35)、(0.64±0.38)mm2,D组显著小于其他各组(P均<0.001),A、B、C组间差异无统计学意义(P>0.05)。A、B、C、D组的中位炎症面积分别为0.22、0.21、0.09、0.00mm2,D组也显著小于其他各组(P=0.009),A、B、C组间差异无统计学意义(P>0.05)。双变量相关分析显示,炎症面积与新生内膜面积间呈显著正相关(r=0.719,P<0.001);在控制支架种类、平均损伤积分和外弹力板围绕面积后,偏相关分析显示两者依然呈显著正相关(r=0.498,P=0.01)。结论炎症可促进冠状动脉支架置入术后新生内膜的增生。雷帕霉素洗脱支架可减少支架置入术后的炎症反应。
Objective To investigate the relationship between inflammatory reaction of vascular wall and neointimal hyperplasia after mini-swine coronary artery stent implantation. Methods Twenty healthy small pigs were randomly divided into group A (L316 stainless steel bare metal stent group), group B (605L cobalt chromium alloy bare metal stent group), group C (PLGA coating 605L stent group) and group D (PLGA coating 605L rapamycin eluting stent group). One pig of the same type was placed in the left anterior descending branch and the right coronary artery of each pig. The coronary stents were stained with a stent at 4 weeks, and the area of inflammation of the coronary artery wall and the area of neointimal area were measured. Its relevance. Results The neointimal areas in groups A, B, C and D were (2.09 ± 0.90), (2.11 ± 1.07), (1.42 ± 0.35) and (0.64 ± 0.38) mm2, respectively, which were significantly lower in group D than those in other groups <0.001). There was no significant difference between A, B and C groups (P> 0.05). The median inflammatory area in groups A, B, C and D were 0.22, 0.21, 0.09 and 0.00 mm2, respectively, which were significantly lower in group D than those in other groups (P = 0.009). There was no significant difference between groups A, B and C (P> 0.05). Bivariate correlation analysis showed that there was a significant positive correlation between inflammatory area and neointimal area (r = 0.719, P <0.001). After controlling the type of scaffolds, the mean lesion score and the area around the outer elastic plate, partial correlation analysis showed that both There was still a significant positive correlation (r = 0.498, P = 0.01). Conclusion Inflammation can promote neointimal hyperplasia after coronary stenting. Rapamycin-eluting stent reduces the inflammatory response after stenting.