刘颖芝 熊振宇 熊龙根

[摘要] 目的 探讨冠心病介入术后缬沙坦对冠脉再狭窄的影响。 方法 选择2016年1月～2017年11月在广州医科大学第二附属医院行冠脉介入术+放支架的患者98例，按照随机抽取病例号原则随机分为实验组（n = 49）和对照组（n = 49）。对照组给予常规治疗，实验组在常规基础上加入缬沙坦胶囊治疗，同时选择30例行冠脉造影但未放支架的作为阴性对照组。分析三组患者超声心动图心室射血分数（EF）值、不良心血管事件、冠脉再狭窄的发生情况和内皮素-1（ET-1）、超敏C反应蛋白（hs-CRP）、白介素-6（IL-6）、脂蛋白相关磷脂酶A2（LP-PLA2）的含量变化。 结果 实验组有5例发生冠脉再狭窄，发生率为10.20%，对照组有13例发生冠脉再狭窄，发生率为26.53%，两组比较差异有统计学意义（P < 0.05）。术后4周，三组患者的ET-1、hs-CRP、IL-6、LP-PLA2、EF值与同组术前比较，差异有统计学意义（P < 0.05）。术后4周，实验组ET-1、hs-CRP、IL-6、LP-PLA2与对照组、阴性对照组比较，差异有统计学意义（P < 0.05），而对照组与阴性对照组比较，差异无统计学意义（P > 0.05）。术后4周，实验组与对照组、阴性对照组EF值比较，差异均有统计学意义（P < 0.05）。實验组的不良心血管事件发生情况较对照组少，差异有统计学意义（P < 0.05）。 结论 冠心病介入术后经缬沙坦治疗后可有效降低冠脉再狭窄的发生，降低内皮素及炎症因子的含量，明显减少不良心血管事件发生，改善超声心动图EF值。

[关键词] 冠心病介入术；缬沙坦；冠脉再狭窄

[中图分类号] R541.4 [文献标识码] A [文章编号] 1673-7210（2018）08（a）-0081-04

[Abstract] Objective To investigate the effect of Valsartan on coronary restenosis after coronary intervention. Methods A total of 98 patients who underwent coronary intervention and stent placement at the Second Affiliated Hospital of Guangzhou Medical University from January 2016 to November 2017 were randomly divided into experimental group （n = 49） and control group （n = 49） according to the principle of randomly selected case numbers. The control group received routine treatment. The experimental group were treated with Valsartan Capsules on the basis of routine treatment. At the same time， 30 patients who underwent coronary angiography without stenting were selected as negative control group. The echocardiographic EF values， the occurrence of adverse cardiovascular events and coronary restenosis， and the contents of endothelin-1 （ET-1）， high-sensitivity C-reactive protein （hs-CRP）， interleukin-6 （IL-6）， lipoprotein-related phospholipids and enzyme A2 （LP-PLA2） were analyzed in the three groups of patients. Results In the experimental group， there were 5 cases with coronary restenosis， with an incidence of 10.20%. In the control group， coronary restenosis occurred in 13 cases with an incidence of 26.53%， and the difference between the two groups was statistically significant （P < 0.05）. The ET-1， hs-CRP， IL-6， LP-PLA2 and EF values of the three groups 4 weeks after surgery were compared with those before surgery， and the differences were statistically significant （P < 0.05）. Four weeks after surgery， the differences of ET-1， hs-CRP， IL-6， LP-PLA2 and EF values in the experimental group， the control group and the negative control group were statistically significant （P < 0.05）. Four weeks after surgery， experimental ET - 1， the hs-CRP， IL-6， LP-PLA2 were compared with control group， negative control group， and the differences were statistically significant （P < 0.05）， while the control group compared with negative control group， there was no statistically significant difference （P > 0.05）. Echocardiographic EF values of the experimental group， the control group and the negative control group were compared with those of the same group 4 weeks after surgery， and the differences were statistically significant （P < 0.05）. EF values of the experimental group compared to control group， the difference was statistically significant （P < 0.05）. The incidence of adverse cardiovascular events in the experimental group were less than that in the control group， and the difference was statistically significant （P < 0.05）. Conclusion After coronary intervention， valsartan can effectively reduce the incidence of coronary restenosis， reduce the content of endothelin and inflammatory cytokines， and significantly improve the occurrence of adverse cardiovascular events and echocardiographic EF values.

[Key words] Coronary； Intervention； Valsartan； Coronary restenosis

冠状动脉粥样硬化性心脏病是冠状动脉血管发生动脉粥样硬化病变而引起血管腔狭窄或阻塞，造成心肌缺血、缺氧或坏死而导致的心脏病，常常被称为“冠心病”[1]。是临床上较为常见的心血管疾病，其治疗方式主要为经皮冠状动脉介入术（PCI），但是在接受PCI治疗后，存在再次狭窄的风险，这就需要临床医生通过药物治疗，降低PCI术后冠脉再狭窄的发生，改善患者的生活治疗。有研究发现PCI术后发生再狭窄与血管内皮病变及炎症相关[2-3]，这为预防PCI术后发生再狭窄提供了研究思路。血管紧张素Ⅱ（AngⅡ）受体拮抗剂具有扩张血管、抗细胞增殖、调节细胞凋亡等作用[5-8]，可能对PCI术后患者发生再狭窄具有改善作用。……