王斌达+唐维国

[摘要] 目的 观察颅内动脉狭窄患者血管内支架成形术前后凝血功能、活化血小板以及C反应蛋白与血管再狭窄的关系。 方法 随机选择本院20例接受血管内支架成形术的颅内动脉狭窄患者，于术前、术后3 d及术后12个月检查凝血功能、活化血小板以及C反应蛋白水平，并对术后血管再狭窄及无再狭窄患者的凝血功能、活化血小板以及C反应蛋白水平进行比较。选择同期20 例健康体检者作为对照组。采用免疫散射比浊法测定血清CRP含量；血浆凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）用凝固法；血小板活化指标中P选择素（CD62p）、糖蛋白（GP）Ⅱb/Ⅲa受体复合物用流式细胞仪测定。 结果 颅内动脉狭窄患者血管内支架成形术后3 d及术后12个月的血清凝血功能指标、活化血小板以及C反应蛋白水平均明显高于术前（P均<0.05）。再狭窄组术后12个月时凝血功能、活化血小板及C反应蛋白水平明显高于无狭窄组（P<0.05）。 结论 颅内动脉狭窄患者行血管内支架成形术可导致血浆凝血功能激活，活化血小板以及C反应蛋白水平增高，而且上述指标随访期间高表达是支架术后再狭窄的危险因素。

[关键词] 颅内动脉；支架；凝血功能；活化血小板；C反应蛋白；再狭窄

[中图分类号] R743.3 [文献标识码] A [文章编号] 1673-9701（2014）17-0025-04

The risk factors of restenosis after intracranial arterial stenosis stent angioplasty

WANG Binda TANG Weiguo

Department of Neurology， Zhoushan Hospital of Zhejiang Province， Zhoushan 316000， China

[Abstract] Objective To investigate the relationship between clotting， platelet activation， C-reactive protein before and after intracranial arterial stenosis stent angioplasty and vascular restenosis. Methods Twenty patients with intracranial arterial stenosis were selected and given stent angioplasty. Before angioplasty， 3 d and 12 months after angioplasty，the clotting， platelet activation， C-reactive protein were detected， and these indexes were compared between patients with and without restenosis. 20 cases of healthy people in the same period were selected as control group. Serum CRP levels were detected by immune scattering nephelometry， prothrombin time （PT）， thrombin time （TT）， activated partial thromboplastin time （APTT） were detected by coagulation； Platelet activation markers sunch as P-selectin （CD62p）， glycoprotein （GP） Ⅱb / Ⅲa receptor complex were determined by flow cytometry. Results In 3 d and 6 to 12 months after angioplasty， serum coagulation function， platelet activation and C-reactive protein levels were significantly higher than that before surgery（P all <0. 05）. The serum coagulation function， platelet activation and C-reactive protein levels of restenosis group were significantly higher than no-restenosis group（P <0.05）. Conclusion In patients with intracranial arterial stenosis， the stent procedures can lead the ctivation of serum coagulation function and increase platelet， C-reactive protein level. So high expression of these index are the risk factors of stent restenosis.

[Key words] Intracranial artery； Stent； Coagulation； Activated platelets； C-reactive protein； Restenosis

研究显示支架植入术后再狭窄的发生机制主要是由于一系列神经内分泌因素参与的炎症反应导致血管内膜增生、平滑肌增殖，导致支架内再狭窄[1，2]。因此了解参与支架内再狭窄的各种炎症因子及血清凝血因子的水平变化，对临床早期预防性干预、防止支架内再狭窄发生有重要意义。研究显示活化血小板、C反应蛋白、血清纤维蛋白原等因子在再狭窄发生及发展中有重要作用，其中C反应蛋白是一种急性时相蛋白，对心脑血管时间有独立的预测价值[3]；……