冠状动脉成形术后使用苯扎贝特预防再狭窄

Prevention of restenosis by bezafibrate after successful coronary angioplasty.

作者信息

Ishiwata S, Nakanishi S, Nishiyama S, Seki A

机构信息

Cardiovascular Center, Toranomon Hospital, Tokyo, Japan.

出版信息

Coron Artery Dis. 1995 Nov;6(11):883-9.

PMID:8696533

Abstract

BACKGROUND

To study the role of bezafibrate in prevention of restenosis after successful percutaneous transluminal coronary angioplasty (PTCA), we evaluated the incidence of restenosis and its correlation with serum lipid levels and effects on the coagulation-fibrinolytic system.

METHODS

Subjects who had undergone successful elective PTCA were classified into three groups based on their triglyceride level and whether or not bezafibrate was administered. Fifty-two patients who had a triglyceride level < 150 mg/dl were classified as group A. Those with a triglyceride level +/- 150 mg/dl were randomly and prospectively allocated to receive either bezafibrate (group B, n = 21), or no lipid-lowering treatment (group C, n = 22). The restenosis rates in all three groups were subsequently monitored and correlated with serum levels of lipids and coagulation-fibrinolytic system markers.

RESULTS

In the bezafibrate group, three of 21 patients (14%) had restenosis compared with 12 of 22 (55%) in group C and 18 of 52 (35%) in group A. In groups A and C, fibrinogen and triglyceride levels were significantly higher in the patients with restenosis. At the time of re-evaluation, serum triglyceride, fibrinogen, and plasminogen activator inhibitor type 1 (PAI-1) levels were lower and high-density lipoprotein (HDL) cholesterol levels were higher in the bezafibrate group than in group C. By logistic regression analysis, triglyceride and PAI-1 were found to be significant risk factors for postangioplasty restenosis.

CONCLUSIONS

Triglyceride is a risk factor for post-PTCA restenosis, and bezafibrate reduces the post-PTCA restenosis rate in patients with a high triglyceride level. In the bezafibrate group, a significant decrease in PAI-1 was observed in association with a decrease in triglyceride level and an elevation of HDL cholesterol level. This suggests that improvement in fibrinolytic capacity is involved in the mechanism of decrease in the rate of restenosis.

摘要

背景

为研究苯扎贝特在成功的经皮腔内冠状动脉成形术（PTCA）后预防再狭窄中的作用，我们评估了再狭窄的发生率及其与血脂水平的相关性以及对凝血纤溶系统的影响。

方法

根据甘油三酯水平以及是否给予苯扎贝特，将成功接受择期PTCA的受试者分为三组。52例甘油三酯水平<150mg/dl的患者被归为A组。甘油三酯水平±150mg/dl的患者被随机且前瞻性地分配接受苯扎贝特治疗（B组，n = 21）或不接受降脂治疗（C组，n = 22）。随后监测所有三组的再狭窄率，并将其与血脂水平和凝血纤溶系统标志物进行相关性分析。

结果

在苯扎贝特组中，21例患者中有3例（14%）发生再狭窄，而C组22例中有12例（55%），A组52例中有18例（35%）。在A组和C组中，发生再狭窄的患者纤维蛋白原和甘油三酯水平显著更高。在重新评估时，苯扎贝特组的血清甘油三酯、纤维蛋白原和1型纤溶酶原激活物抑制剂（PAI-1）水平较低，高密度脂蛋白（HDL）胆固醇水平较高。通过逻辑回归分析，发现甘油三酯和PAI-1是血管成形术后再狭窄的重要危险因素。