张弘宇+李敏+徐春冬

[摘要] 目的 研究瑞舒伐他汀与晚期支架贴壁不良的相关性。 方法 选取63例患者，将其分为治疗组和对照组，其中治疗组35例，支架置入术前后持续口服瑞舒伐他汀10 mg，1次/d，至复查造影时；对照组28例，支架置入术前后不服或服用瑞舒伐他汀10 mg，1次/d，总时间少于4周。两组患者支架置入后即刻行血管内超声检查（IVUS），且在支架置入后6～9个月复查IVUS和冠状动脉造影。两次住院期间均检测血清高敏C-反应蛋白（hs-CRP）和低密度脂蛋白胆固醇（LDL-C）。 结果 治疗组有3例患者发生晚期支架贴壁不良，共计4个部位；对照组为8例，共13个部位；两组差异有统计学意义（P<0.05）。治疗组血管外弹力膜增加面积、中膜增加面积、管腔减少面积、内膜增生横截面积均小于对照组，差异有统计学意义（P<0.05）。治疗组两次住院期间hs-CRP和LDL-C水平的变化显著优于对照组（P<0.01）。 结论 瑞舒伐他汀能够降低晚期支架贴壁不良的发生率，减轻非特异性炎症反应，降低LDL-C水平。

[关键词] 瑞舒伐他汀；支架贴壁不良；血管内超声；高敏C-反应蛋白；低密度脂蛋白胆固醇

[中图分类号] R972[文献标识码] A[文章编号] 1674-4721（2014）04（c）-0099-03

The effect of rosuvastatin on late stent malapposition

ZHANG Hong-yu LI Min XU Chun-dong

Department of Cardiology,the Central Hospital of Jilin City in Jilin Province,Jilin 132011,China

[Abstract] Objective To investigate the correlation between rosuvastatin and late stent malapposition (LSM).Methods 63 cases of patients were divided into treatment group and control group,35 patients in treatment group were continuously taken rosuvastatin administration 10 mg qd before and after percutaneous coronary implantation (PCI).28 patients in control group were not taken rosuvastatin or taken rosuvastatin administration 10 mg qd less than 4 weeks.All cases were performed intravascular ultrasound (IVUS) immediately after PCI.And they were reexamined IVUS and angiography in 6-9 month after PCI.Serum high-sensitivity C-reactive protein (hs-CRP) and low density lipoprotein cholesterol (LDL-C) were tested during in-hospital.Results Three patients appeared LSM in treatment group,a total of 4 places.By contrast,eight patients were examined LSM in control group,a total of 13 places;two groups had significant difference (P<0.05); Increase the area of the external elastic membrane,the membrane increase the area,reducing the area of the lumen,intimal hyperplasia cross-sectional area in treatment group was less than that of the control group respectively (P<0.05).The changes of hs-CRP and LDL-C levels in treatment group were more obvious than those in control group (P<0.01).Conclusion Rosuvastatin can decrease the incidence of LSM.It also can alleviate the level of inflammatory factor and blood lipid.

[Key words] Rosuvastatin;Stent malapposition;Intravascular ultrasound;High-sensitivity C-reactive protein;Low density lipoprotein cholesterol

冠心病是致人类死亡的主要杀手之一，支架置入是治疗冠心病的重要手段。但支架置入随之而来的冠状动脉血管再狭窄是临床医生最初未曾预料到的，一直以来，支架内血栓就是心内科医生最为棘手的、最亟待解决的问题。新近研究表明支架贴壁不良与支架内血栓形成密切相关。Ozaki等[1]采用光学相干断层成像（OCT）证实，术后10个月发生支架内血栓的患者其支架梁明显高于贴壁良好者。Hassan等[2]研究表明，晚期支架贴壁不良组相对于支架贴壁良好组发生极晚期支架内血栓的危险性升高。因此预防支架贴壁不良的发生对于减少支架血栓具有重要临床意义。

瑞舒伐他汀具有改善血管内皮功能、抑制平滑肌细胞增殖与迁移、减少氧自由基产生、促进一氧化碳分泌等作用[3]，是迄今为止临床上作用较强的他汀类，也是唯一能够逆转冠状动脉硬化的他汀，成为治疗冠心病的一线药物。……