经皮冠状动脉腔内成形术后炎性反应与再狭窄关系的研究(摘要)
作者：刘欣 方唯一
单位：辽宁省，大连鞍钢铁西医院 心内科(116000) 刘 欣；辽宁省，大连医科大学附属第一医院 方唯一
关键词：
中国循环杂志99zk68 目的：通过比较经皮冠状动脉腔内成形术(PTCA)及冠状动脉造影术(CAG)术前、术后血浆CRP浓度变化，探讨PTCA术是否可触发炎性反应及CRP在PTCA术后病人的预后判断方面的临床意义。
方法：选择1998年1月～1999年1月期间在大连医科大学附属一院住院行PTCA术病人67例，其中63例置入支架，对照组为34例只行CAG术的病人，分别在术前24小时内、术后48小时取血测CRP，为明确PTCA术后有无微小心肌损伤，分别在术前24小时内和术后18～24小时取血测肌酸激酶MB同工酶(CK-MB)及肌钙蛋白Ⅰ(cTnI)。
, http://www.100md.com
结果：67例病人PTCA术均成功，包括63例置入支架，89处病变经治疗后管腔狭窄由(88±10)%减少到(19±11)%。PTCA术后CRP由4.8±3.4 mg/L升高到28±22 mg/L(P<0.001),但对照组CRP则无明显变化(7.2±6.5 mg/L比8.4±5.6 mg/L),CK-MB仅4例病人发现升高，有24例cTnI轻度升高(35.8%)，但均低于2.5 μg/ml[排除急性心肌梗塞(AMI)]。PTCA术后cTnⅠ升高与cTnⅠ无变化病人的CRP分别为33.4±28 mg/L和24.6±15.7 mg/L(P=NS)。1例PTCA术后CRP最高(113 mg/L)病人因再狭窄而导致AMI。PTCA术后6个月，7例CRP>60 mg/L病人中的3例及60例CRP<60 mg/L病人中1例因同一病变部位发生再狭窄而行再次PTCA术(P<0.025)。
结论：PTCA术可引起斑块破裂、出血、血管壁损伤，导致白细胞及血小板释放炎性介质及组织因子等。本文结果显示PTCA术后CRP升高，PTCA术可触发以CRP升高为特征的炎性反应，而与心导管术本身及微小心肌损伤无关。在术后随访的6个月中，血浆CRP浓度高的病人再狭窄率显著增高，故根据PTCA术后病人的血浆CRP浓度可判断术后病人的预后，对估计发生再狭窄的高危人群有一定意义。
, 百拇医药
The Relation Between Inflammatory Response and Restenosis after Percutaneous Transluminal Coronary Angioplasty (Abstract)
Department of Cardiology,The Tiexi Hospital of Anshan iron and steel company, Dalian (116000), Liaoning
Liu Xin, Fang Weiyi.
Objective: This study was to compare CRP levels at baseline and after the procedure in patients undergoing percutaneous transluminal coronary angioplasty (PTCA) and in controls undergoing coronary angiography and to determine whether PTCA induces a systemic inflammatory reaction and whether CRP may offer prognostic information after PTCA and identify a subgroup of patients at high risk for restonesis.
, 百拇医药
Methods: Sixty-seven patients who underwent PTCA in the First Hospital of Dalian Medical University from January 1998 to January 1999 were enrolled in this study, of whom 63 had stent placement, and 34 controls who had coronary angiography only. CRP was measured in both groups within 24 hours befroe, and 48 hours after PTCA or angiography. To assess minor myocardial damage induced by balloon inflation, MB isoenzyme of creatine kinase (CK-MB) isoenzyme and cardiac troponin Ⅰ were measured within 24 h before and 18 to 24 hours after PTCA.
, 百拇医药
Results: PTCA was successful in all 67 patients including 63 who received stents. The mean diameter stenosis of the 89 treated lesions was reduced from (88±10)% to (19±11)%. CRP levels increased from 4.8±3.4 mg/L before PTCA to 28±22 mg/L after the procedure (p<0.001), but did not change significantly in controls (7.2±6.5 mg/L vs. 8.4±5.6 mg/L). CK-MB elevatioins were noted in 4 patients and cardiac troponin Ⅰ levels were lightly elevated in 24 patients (35.8%), but below the 2.5 μg/ml [cutoff acute myocardial infarction (AMI)]. The CRP level after PTCA in patient with and without a lightly troponin Ⅰ elevation were 33.4±2.8 mg/L and 24.6±15.7 mg/L respectively (p=NS). 1 patient with the highest CRP level after PTCA (113 mg/L) occured again with AMI because of restenosis. During 6 months after PTCA, 3 of the 7 patients with CRP level >60 mg/L and 1 of the 60 patients with CRP level <60 mg/L underwent repeat target vessel PTCA because of restenosis (p<0.025).
, 百拇医药
Conclusion: PTCA causes plague rupture, hemorrhage, arterial wall damage, and the release of inflammatory and chemoattractant factors with leukocyte and platelet activation. This study showed that PTCA may induce CRP levels significantly increasing in some patients. PTCA triggers a inflammatory response which is independent of the catheterization and minor myocardial damage. The patients with high CRP level after PTCA showed a high rate of restenosis in the 6-month follow-up. So the CRP level may offer prognostic information after PTCA and identify a subgroup patients at high risk for restenosis., 百拇医药
单位：辽宁省，大连鞍钢铁西医院 心内科(116000) 刘 欣；辽宁省，大连医科大学附属第一医院 方唯一
关键词：
中国循环杂志99zk68 目的：通过比较经皮冠状动脉腔内成形术(PTCA)及冠状动脉造影术(CAG)术前、术后血浆CRP浓度变化，探讨PTCA术是否可触发炎性反应及CRP在PTCA术后病人的预后判断方面的临床意义。
方法：选择1998年1月～1999年1月期间在大连医科大学附属一院住院行PTCA术病人67例，其中63例置入支架，对照组为34例只行CAG术的病人，分别在术前24小时内、术后48小时取血测CRP，为明确PTCA术后有无微小心肌损伤，分别在术前24小时内和术后18～24小时取血测肌酸激酶MB同工酶(CK-MB)及肌钙蛋白Ⅰ(cTnI)。
, http://www.100md.com
结果：67例病人PTCA术均成功，包括63例置入支架，89处病变经治疗后管腔狭窄由(88±10)%减少到(19±11)%。PTCA术后CRP由4.8±3.4 mg/L升高到28±22 mg/L(P<0.001),但对照组CRP则无明显变化(7.2±6.5 mg/L比8.4±5.6 mg/L),CK-MB仅4例病人发现升高，有24例cTnI轻度升高(35.8%)，但均低于2.5 μg/ml[排除急性心肌梗塞(AMI)]。PTCA术后cTnⅠ升高与cTnⅠ无变化病人的CRP分别为33.4±28 mg/L和24.6±15.7 mg/L(P=NS)。1例PTCA术后CRP最高(113 mg/L)病人因再狭窄而导致AMI。PTCA术后6个月，7例CRP>60 mg/L病人中的3例及60例CRP<60 mg/L病人中1例因同一病变部位发生再狭窄而行再次PTCA术(P<0.025)。
结论：PTCA术可引起斑块破裂、出血、血管壁损伤，导致白细胞及血小板释放炎性介质及组织因子等。本文结果显示PTCA术后CRP升高，PTCA术可触发以CRP升高为特征的炎性反应，而与心导管术本身及微小心肌损伤无关。在术后随访的6个月中，血浆CRP浓度高的病人再狭窄率显著增高，故根据PTCA术后病人的血浆CRP浓度可判断术后病人的预后，对估计发生再狭窄的高危人群有一定意义。
, 百拇医药
The Relation Between Inflammatory Response and Restenosis after Percutaneous Transluminal Coronary Angioplasty (Abstract)
Department of Cardiology,The Tiexi Hospital of Anshan iron and steel company, Dalian (116000), Liaoning
Liu Xin, Fang Weiyi.
Objective: This study was to compare CRP levels at baseline and after the procedure in patients undergoing percutaneous transluminal coronary angioplasty (PTCA) and in controls undergoing coronary angiography and to determine whether PTCA induces a systemic inflammatory reaction and whether CRP may offer prognostic information after PTCA and identify a subgroup of patients at high risk for restonesis.
, 百拇医药
Methods: Sixty-seven patients who underwent PTCA in the First Hospital of Dalian Medical University from January 1998 to January 1999 were enrolled in this study, of whom 63 had stent placement, and 34 controls who had coronary angiography only. CRP was measured in both groups within 24 hours befroe, and 48 hours after PTCA or angiography. To assess minor myocardial damage induced by balloon inflation, MB isoenzyme of creatine kinase (CK-MB) isoenzyme and cardiac troponin Ⅰ were measured within 24 h before and 18 to 24 hours after PTCA.
, 百拇医药
Results: PTCA was successful in all 67 patients including 63 who received stents. The mean diameter stenosis of the 89 treated lesions was reduced from (88±10)% to (19±11)%. CRP levels increased from 4.8±3.4 mg/L before PTCA to 28±22 mg/L after the procedure (p<0.001), but did not change significantly in controls (7.2±6.5 mg/L vs. 8.4±5.6 mg/L). CK-MB elevatioins were noted in 4 patients and cardiac troponin Ⅰ levels were lightly elevated in 24 patients (35.8%), but below the 2.5 μg/ml [cutoff acute myocardial infarction (AMI)]. The CRP level after PTCA in patient with and without a lightly troponin Ⅰ elevation were 33.4±2.8 mg/L and 24.6±15.7 mg/L respectively (p=NS). 1 patient with the highest CRP level after PTCA (113 mg/L) occured again with AMI because of restenosis. During 6 months after PTCA, 3 of the 7 patients with CRP level >60 mg/L and 1 of the 60 patients with CRP level <60 mg/L underwent repeat target vessel PTCA because of restenosis (p<0.025).
, 百拇医药
Conclusion: PTCA causes plague rupture, hemorrhage, arterial wall damage, and the release of inflammatory and chemoattractant factors with leukocyte and platelet activation. This study showed that PTCA may induce CRP levels significantly increasing in some patients. PTCA triggers a inflammatory response which is independent of the catheterization and minor myocardial damage. The patients with high CRP level after PTCA showed a high rate of restenosis in the 6-month follow-up. So the CRP level may offer prognostic information after PTCA and identify a subgroup patients at high risk for restenosis., 百拇医药