Tian Feng, Chen Yundai, Liu Hongbin, Zhang Tao, Guo Jun, Jin Qinhua
Department of Cardiology, Chinese PLA General Hospital, Beijing, PR China.
Cardiology. 2014;128(1):34-40. doi: 10.1159/000357612. Epub 2014 Feb 7.
This study aims to assess the characteristics of neointimal hyperplasia after drug-eluting stent (DES) implantation in patients with diabetes mellitus (DM) by optical coherence tomography (OCT).
OCT was performed in 109 patients (45 with DM and 64 without DM) 1 year after DES implantation. Neointimal coverage and thickness on the luminal side were measured. The characteristics of neointimal hyperplasia were classified into three patterns, namely, high signal pattern, low signal pattern and layered signal pattern, according to the neointimal signal intensity. The development of in-stent neoatherosclerosis was also examined. In the DM group, glycated hemoglobin (HbA1c) levels were analyzed in order to assess their contribution to neointimal characteristics.
OCT results indicated that neointimal thickness was thicker in the DM group than in the non-DM group (177.19 ± 165.36 vs. 166.76 ± 132.38 μm, p < 0.001). Lower incidence of high signal pattern (58.33 vs. 75.34%, p = 0.037) and higher incidence of in-stent neoatherosclerosis (18.33 vs. 5.48%, p = 0.027) were observed in the DM group. In the DM subgroup with HbA1c >7%, significantly higher incidence of low signal pattern (37.50 vs. 21.43%, p = 0.001) and layered signal pattern (18.75 vs. 3.57%, p = 0.001) and lower incidence of high signal pattern were observed (43.75 vs. 75.0%, p < 0.001). In-stent neoatherosclerosis was also frequently detected in the high HbA1c group compared with the low HbA1c group (28.13 vs. 7.14%, p = 0.048).
Neointimal characteristics differed between DM and non-DM patients. HbA1c levels in DM patients contributed to the development of neointimal hyperplasia and in-stent neoatherosclerosis.
本研究旨在通过光学相干断层扫描（OCT）评估糖尿病（DM）患者药物洗脱支架（DES）植入术后新生内膜增生的特征。
对109例患者（45例DM患者和64例非DM患者）在DES植入术后1年进行OCT检查。测量管腔侧新生内膜覆盖面积和厚度。根据新生内膜信号强度，将新生内膜增生的特征分为三种模式，即高信号模式、低信号模式和分层信号模式。同时检查支架内新生动脉粥样硬化的发生情况。在DM组中，分析糖化血红蛋白（HbA1c）水平，以评估其对新生内膜特征的影响。
OCT结果显示，DM组新生内膜厚度比非DM组厚（177.19±165.36 vs. 166.76±132.38μm，p<0.001）。DM组高信号模式发生率较低（58.33% vs. 75.34%，p = 0.037），支架内新生动脉粥样硬化发生率较高（18.33% vs. 5.48%，p = 0.027）。在HbA1c>7%的DM亚组中，低信号模式（37.50% vs. 21.43%，p = 0.001）和分层信号模式（18.75% vs. 3.57%，p = 0.001）的发生率显著更高，高信号模式发生率更低（43.75% vs. 75.0%，p<0.001）。与低HbA1c组相比，高HbA1c组也经常检测到支架内新生动脉粥样硬化（28.13% vs. 7.14%，p = 0.048）。
DM患者和非DM患者的新生内膜特征不同。DM患者的HbA1c水平促进了新生内膜增生和支架内新生动脉粥样硬化的发展。
