Hitsumoto Takashi, Takahashi Mao, Iizuka Takuo, Shirai Kohji
Division of Internal Medicine, Sakura Hospital, Toho University School of Medicine, Chiba.
J Cardiol. 2006 Aug;48(2):65-73.
Insulin resistance or inflammation is known to be related with lipoprotein lipase activity and these factors are also closely associated with the pathogenesis of bare-metal stent restenosis. This study examined the relationship between preheparin lipoprotein lipase protein (preheparin LpL mass) concentration in serum and bare-metal stent restenosis.
A total of 121 lesions in 112 patients who underwent bare-metal stent implantation using NIR stent or S660/670 stent were examined. Subjects were divided into two groups (N group; patients with normal preheparin LpL mass concentration, n = 50 or L group; patients with low preheparin LpL mass concentration, n = 71) according to the mean levels of preheparin LpL mass concentration (male 39.3 ng/ml, female 50.6 ng/ml).
There were no differences in percutaneous coronary intervention or angiographical characteristics. The L group had a significantly higher incidence of restenosis rate and target lesion revascularization than the N group (N group vs L group: 8.0% vs 42.3%, p < 0.0001; 8.0% vs 33.8%, p = 0.0008, respectively). Homeostatic model assessment of insulin resistance as a marker of insulin resistance and high sensitive C-reactive protein concentration were significantly higher in the L group than the N group. Multiple regression analysis showed that only low preheparin LpL mass concentration was an independent factor for restenosis (t value = 3.6, p = 0.0005).
Preheparin LpL mass concentration is closely associated with bare-metal stent restenosis and preheparin LpL mass concentration may be an important marker for the selection of bare-metal stent or drug-eluting stent.
胰岛素抵抗或炎症与脂蛋白脂肪酶活性相关，且这些因素也与裸金属支架再狭窄的发病机制密切相关。本研究探讨血清中肝素前脂蛋白脂肪酶蛋白（肝素前LpL质量）浓度与裸金属支架再狭窄之间的关系。
对112例行NIR支架或S660/670支架裸金属支架植入术患者的121个病变进行检查。根据肝素前LpL质量浓度的平均水平（男性39.3 ng/ml，女性50.6 ng/ml）将受试者分为两组（N组；肝素前LpL质量浓度正常的患者，n = 50；或L组；肝素前LpL质量浓度低的患者，n = 71）。
经皮冠状动脉介入治疗或血管造影特征方面无差异。L组的再狭窄率和靶病变血运重建发生率显著高于N组（N组 vs L组：分别为8.0% vs 42.3%，p < 0.0001；8.0% vs 33.8%，p = 0.0008）。作为胰岛素抵抗标志物的胰岛素抵抗稳态模型评估和高敏C反应蛋白浓度在L组显著高于N组。多元回归分析显示，只有低肝素前LpL质量浓度是再狭窄的独立因素（t值 = 3.6，p = 0.0005）。
肝素前LpL质量浓度与裸金属支架再狭窄密切相关，肝素前LpL质量浓度可能是选择裸金属支架或药物洗脱支架的重要标志物。
