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目的比较药物涂层支架(DES)与金属裸支架(BMS)置入前后冠状动脉循环内局部血浆组织因子(TF)水平的变化,探讨DES对血浆TF水平的早期改变及其对急性支架内血栓(AST)形成的意义。方法入选稳定型心绞痛患者26例,按标准方法行冠状动脉造影证实有冠状动脉狭窄均在70%以上。其中15例置入DES(DES组),11例置入BMS(BMS组)。全部患者术前给予阿司匹林、氯吡格雷口服,支架置入前静脉给予低分子质量肝素。PCI术中冠状动脉内血样采集顺序依次为:支架置入前后冠状动脉入口处(ostium)用引导导管,支架置入后15 min通过血栓吸引器穿过病灶在病灶下方(beyond the lesion)采血。血浆TF水平检测采用酶联免疫双抗体夹心法(ELISA)。结果PCI术前26例患者在冠状动脉入口处与病灶下方冠状动脉循环内的TF基线水平比较差异无统计学意义(31.50±7.05 ng/L比31.40±7.30 ng/L,P=0.748),但高于正常参考值3倍;支架置入后15min在冠状动脉入口处(29.60±6.96 ng/L比31.50±7.05 ng/L,P=0.135)与病灶下方(30.70±7.70 ng/L比31.40±6.30 ng/L,P=0.230)冠状动脉循环内的TF水平与术前比较,差异亦无统计学意义。术后15min,DES组和BMS组冠状动脉入口处(31.20±4.37 ng/L比30.70±5.39 ng/L,P=0.674)及病灶下方(31.60±5.39 ng/L比29.00±7.96 ng/L,P=0.789)TF水平差异均无统计学意义。结论稳定型心绞痛患者冠状动脉循环血内存在大量的TF。DES和BMS两种支架均不引起冠状动脉内局部、早期血浆TF水平的改变。
Objective To compare the changes of local plasma levels of tissue factor (TF) in coronary circulation before and after drug-eluting stent (DES) and bare metal stent (BMS) implantation, and to explore the early changes of plasma TF and its effect on acute stent thrombosis (AST) the formation of significance. Methods Twenty-six patients with stable angina were enrolled. Coronary artery stenosis was confirmed by coronary angiography in more than 70% of the patients according to the standard method. Of these, 15 were placed in DES (DES) and 11 in BMS (BMS). All patients were given aspirin preoperatively and oral clopidogrel, and low molecular weight heparin was given to the anterior vein of the stent. The sequence of blood samples collected from the coronary arteries during PCI was as follows: ostium of the ostium before and after stent placement, and blood was drawn beyond the lesion through the thrombus aspirator through the lesion 15 min after stent placement. Plasma TF levels were detected by enzyme-linked immunosorbent assay (ELISA). Results There was no significant difference in the baseline levels of TF between the coronary artery entrance and coronary artery circulation in the 26 patients before PCI (31.50 ± 7.05 ng / L vs. 31.40 ± 7.30 ng / L, P = 0.748) (29.60 ± 6.96 ng / L vs. 31.50 ± 7.05 ng / L, P = 0.135) and below the lesion (30.70 ± 7.70 ng / L vs. 31.40 ± 6.30 ng / L, P = 0.230) There was no significant difference in the level of TF in coronary circulation compared with that before operation. At 15 min after PCI, the coronary artery entrance (31.20 ± 4.37 ng / L vs 30.70 ± 5.39 ng / L, P = 0.674) and below the lesion (31.60 ± 5.39 ng / L vs 29.00 ± 7.96 ng / L, P = 0.789) TF level differences were not statistically significant. Conclusion There is a large amount of TF in coronary blood in patients with stable angina pectoris. Both DES and BMS scaffolds did not cause changes in local and early plasma levels of TF in the coronary arteries.