Zurakowski Aleksander, Wojakowski Wojciech, Dzielski Tadeusz, Milewski Krzysztof, Gościńska-Bis Kinga, Tendera Michał, Buszman Paweł
III Klinika Kardiologii, Slaski Uniwersytet Medyczny, Górnoślaski Ośrodek Kardiologii, ul. Ziołowa 47, 40-635 Katowice, Poland.
Kardiol Pol. 2009 Jun;67(6):623-30.
In-stent restenosis (ISR) is one of the major limitations of percutaneous coronary intervention (PCI).
To evaluate the relationship between the levels of hs-CRP, IL-6, IL-10 and intimal hyperplasia six months after coronary bare metal stent (BMS) implantation.
The study population consisted of 73 consecutive patients who underwent bare metal stent implantation into narrowed coronary segments. A total of 74 stents were implanted. Angiographic study after six months, together with evaluation of serum level of IL-6 (pg/ml), IL-10 (pg/ml), hs-CRP (microg/ml), fasting insulin (microIU/ml) and glucose (mg%) was performed. Insulin sensitivity was calculated using the HOMA-IR formula. The QCA analysis of stented segments was performed at baseline, after intervention and at six-month follow-up.
Restenosis at six months occurred in 10 patients (13.7%). The mean % diameter stenosis at follow-up was 27.8 +/- 19% and late loss was 0.81 +/- 0.6 mm. We found a correlation between late loss and serum hs-CRP, IL-6 and IL-10 concentration. There was no correlation between the lipid profiles, insulin levels and HOMA-IR and re-narrowing of the stented segments. Patients with restenosis were characterised by significantly higher serum concentration of CRP (2.04 +/- 3.4 vs. 10.38 +/- 6.7 microg/ml, p = 0.0036), IL-6 (14.98 +/- 8.3 vs. 5.70 +/- 5.5 pg/ml, p = 00062), and fasting glucose (184.0 +/- 50.5 vs. 107.5 +/- 40.4 mg%, p = 0.0051), as well as lower IL-10 levels (1.25 +/- 0.6 vs. 4.85 +/- 4.9 pg/ml, p = 0.0000). The ROC analysis indicated that CRP (> 2.86 microg/ml), IL-6 (> 6.24 pg/ml) and IL-10 (< 1.7 pg/ml) values predicted the restenosis with reasonable accuracy. A multiple logistic regression model identified CRP and IL-10 levels as independent predictors of restenosis.
We demonstrated that elevated inflammatory markers 6 months after PCI are associated with late angiographic in-stent restenosis.
支架内再狭窄（ISR）是经皮冠状动脉介入治疗（PCI）的主要局限性之一。
评估冠状动脉裸金属支架（BMS）植入6个月后hs-CRP、IL-6、IL-10水平与内膜增生之间的关系。
研究人群包括73例连续患者，这些患者在狭窄的冠状动脉节段植入了裸金属支架。共植入74枚支架。6个月后进行血管造影研究，并评估血清IL-6（pg/ml）、IL-10（pg/ml）、hs-CRP（μg/ml）、空腹胰岛素（μIU/ml）和葡萄糖（mg%）水平。使用HOMA-IR公式计算胰岛素敏感性。在基线、干预后和6个月随访时对植入支架的节段进行QCA分析。
10例患者（13.7%）在6个月时发生再狭窄。随访时平均直径狭窄百分比为27.8±19%，晚期管腔丢失为0.81±0.6mm。我们发现晚期管腔丢失与血清hs-CRP、IL-6和IL-10浓度之间存在相关性。血脂谱、胰岛素水平和HOMA-IR与植入支架节段的再狭窄之间无相关性。再狭窄患者的特征是血清CRP浓度显著升高（2.04±3.4 vs. 10.38±6.7μg/ml，p = 0.0036）、IL-6（14.98±8.3 vs. 5.70±5.5 pg/ml，p = 0.0062）和空腹血糖（184.0±50.5 vs. 107.5±40.4 mg%，p = 0.0051），以及较低的IL-10水平（1.25±0.6 vs. 4.85±4.9 pg/ml，p = 0.0000）。ROC分析表明，CRP（> 2.86μg/ml）、IL-6（> 6.24 pg/ml）和IL-10（< 1.7 pg/ml）值能以合理的准确性预测再狭窄。多元逻辑回归模型确定CRP和IL-10水平是再狭窄的独立预测因素。
我们证明PCI术后6个月炎症标志物升高与晚期血管造影显示的支架内再狭窄相关。
