Taguchi Isao, Yoneda Shuichi, Abe Shichiro, Toyoda Shigeru, Nasuno Takahisa, Nishino Setsu, Kageyama Michiya, Tokura Michiaki, Ogawa Mikie, Node Koichi, Inoue Teruo
Department of Cardiovascular Medicine, Dokkyo Medical University School of Medicine, 880 Kitakobayashi Mibu, Tochigi, 321-0293, Japan,
Heart Vessels. 2014 Mar;29(2):213-9. doi: 10.1007/s00380-013-0357-7. Epub 2013 May 7.
Recent advances in drug-eluting stent (DES) technology have succeeded in preventing restenosis. In addition to inhibiting smooth muscle cell proliferation, DES greatly inhibits the local inflammatory response in the acute phase after implantation, leading to prevention of restenosis. However, a unique issue in DES implantation is an impairment of reendothelialization, which may result in abnormal wound healing. Consequently, a late-phase inflammatory relapse could appear in the long term after DES implantation. In this study, we measured serum levels of inflammatory markers, including interleukin (IL)-6, IL-8, tumor necrosis factor-α, monocyte chemoattractant protein-1, matrix metalloproteinase-9, and myeloperoxidase, as well as high-sensitivity C-reactive protein at follow-up coronary angiography (mean 9 months) in 54 patients who received DES stenting who did not experience restenosis, and compared them with 51 patients receiving bare-metal stents (BMS) without restenosis. The level of IL-6 was over the measurement threshold (≥2.22 pg/ml) in 12 patients (21 %) in the DES group, but in only 2 patients (4 %) in the BMS group (P = 0.003). IL-8 was significantly higher in the DES group than in the BMS group (4.51 ± 2.40 vs 3.84 ± 1.34 pg/ml, P = 0.015). The levels of other biomarkers were similar between the two groups. DES showed an increase in inflammatory cytokines in the late phase after implantation in comparison with patients who received BMS, suggesting late-stage inflammation. Therefore, the wound-healing response after DES implantation might be different from that after BMS.
药物洗脱支架（DES）技术的最新进展已成功预防再狭窄。除了抑制平滑肌细胞增殖外，DES还能极大地抑制植入后急性期的局部炎症反应，从而预防再狭窄。然而，DES植入中的一个独特问题是内皮再内皮化受损，这可能导致伤口愈合异常。因此，DES植入后长期可能会出现晚期炎症复发。在本研究中，我们在54例接受DES支架置入且未发生再狭窄的患者进行随访冠状动脉造影（平均9个月）时，测量了包括白细胞介素（IL）-6、IL-8、肿瘤坏死因子-α、单核细胞趋化蛋白-1、基质金属蛋白酶-9和髓过氧化物酶在内的炎症标志物的血清水平，以及高敏C反应蛋白，并将其与51例未发生再狭窄的接受裸金属支架（BMS）的患者进行比较。DES组有12例患者（21%）的IL-6水平超过测量阈值（≥2.22 pg/ml），而BMS组仅有2例患者（4%）（P = 0.003）。DES组的IL-8水平显著高于BMS组（4.51±2.40 vs 3.84±1.34 pg/ml，P = 0.015）。两组间其他生物标志物水平相似。与接受BMS的患者相比，DES在植入后期显示炎症细胞因子增加，提示存在晚期炎症。因此，DES植入后的伤口愈合反应可能与BMS不同。
