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目的 :观察支架术后血清淀粉样物质A(SAA)的动态变化 ,比较常规支架术和直接支架术后SAA变化的差异及意义。方法 :选择常规支架术和直接支架术的患者各 4 0例 ,在支架置入前 ,置入后即刻、2 4h、4 8h ,出院前的不同时间段采血测SAA ,比较两组间的差异 ,所有患者随访 6个月 ,观察主要不良心血管事件的发生情况。结果 :常规支架组和直接支架组在支架置入前SAA略高于正常 ,但两组间差异无显著性意义 ,支架置入后即刻开始升高 ,2 4h升高明显 ,4 8h左右达峰值 ,以后缓慢下降 ,出院时仍维持较高水平 ,并且在 2 4、4 8h和出院时两组间差异显著 (P <0 .0 5 ,<0 .0 1,<0 .0 1)。常规支架组总的不良心血管事件发生率为 2 5 .0 % ,直接支架组总的不良事件发生率 7.5 % ,两组间比较差异有显著性意义 (P <0 .0 5 ) ,并且不良事件发生率的高低与出院时的SAA高低相一致。结论 :常规支架术由于反复的球囊预扩张 ,内膜损伤重 ,术后炎症反应剧烈 ,其远期并发症明显多于直接支架术。对一些合适病变 ,可以首选直接支架术。
OBJECTIVE: To observe the dynamic changes of serum amyloid A (SAA) after stenting and to compare the differences and significance of SAA changes after conventional stenting and direct stenting. Methods: 40 cases of patients undergoing conventional stenting and direct stenting were enrolled in this study. SAA was collected before stent placement, immediately after insertion, 24 h, 48 h and before discharge from the hospital, and the differences between the two groups were compared All patients were followed up for 6 months to observe the occurrence of major adverse cardiovascular events. Results: The SAA of the conventional stent group and the direct stent group was slightly higher than that of the normal stent group before stent implantation, but there was no significant difference between the two groups. The stent immediately increased immediately after stent implantation, and increased significantly after 24 h, reaching the peak at 48 h , Then decreased slowly and remained at a high level after discharge. There was a significant difference between the two groups (P <0.05, <0.01, <0.01) at 2, 4 and 8 hours after discharge. The incidence of adverse cardiovascular events was 25.0% in the conventional stent group and 7.5% in the direct stent group, with significant difference between the two groups (P <0.05) The incident rate is consistent with the SAA level at discharge. CONCLUSION: Conventional stenting has more long-term complications than direct stenting due to repeated balloon pre-dilatation, severe intimal injury, and severe postoperative inflammatory response. For some suitable lesions, direct stenting can be preferred.