| Objective1.To investigate the effect of Rosuvastatin on lipid, adiponectin, endothelial function, inflammation and proliferation of smooth muscle cell in the patients with coronary disease after stenting, study and evaluate the effect and mechanism of Rosuvastatin on in-stent restenosis.2.To investigate the the effect of Rosuvastatin on patients with coronary disease after stenting and observe the restenosis of stent. To evaluate the stent frame smoothness, stent diameter, stent lumen density, blood vessel condition of proximal and distal stent, location and severity of ISR by 320 row dynamic volume CT.3.The experimental biochemical and clinical radiology changes of the patients by oral administration of Rosuvastatin after coronary artery stenting were analysed. which evaluate the protection effect of Rosuvastatin on ISR of the patients.Method1.Case information:Fifty-eight patients with coronary artery disease selected from March 2009 to October 2009 in Wuhan General Hospital of Guangzhou Military Command, underwent successful coronary stent implantation, whose age and sex is not limited, With or without history of smoking, hypertension, diabetes mellitus and hyperlipidemia. They were randomly divided into two groups:control (21 cases) group and rosuvastatin treated (37 cases) group. Rosuvastatin treated cases were administrated with rosuvastatin 10mg, PO, once every night. The control group received same treatment except rosuvastatin treatment.The two groups of patients were in similar clinical conditions. The specific treatment measures obtained written consent of all subjects.2.Percutaneous coronary intervention procedure:After femoral (?)rteriopuncture a arterial sheath (6F-7F) was introduced, a catheter from which contrast medium was injected, was engaged at the origin of coronary artery under wire guidance, then multiple posture films were taken to identify the stenosis in the coronary artery. Then a guide catheter was placed near the stenosis and a guide wire (0.014 diameter) was passed into the distal branch, over which a balloon was passed to the stenosis. The balloon was inflated by 6-10 ATM. A stent was then deployed inside the artery and an additional balloon dilation (6-15 ATM) was performed. Coronary angiography showed no stenosis existed, stent in good adherence and then the stent, balloon and catheter were removed.3. Extraction, preservation and inspection of sample:The two groups were respectively collected blood before and one day after PCI, then followed up the first, the third, the sixth month later.They were taken fasting median cubital vein blood with 4ml in the morning to anticoagulant tubes with 0.2ml 2% EDTA, which was centrifuged 10min with 3000r/min, separated serum, packed, well-marked, placed and keeped in the refrigerator with-70℃. After collecting samples ELISA was performed to evaluate the concentration of serum APN, markers of vascular endothelial cell (ET-1, eNOS), markers of smooth muscle cell (MMP-9, MCP-1). Cardiovascular inflammatory marker (hs-CRP) was detected by immune turbidimetry. Serum TC, TG, HDL-C, LDL-C were detected with a Hitachi 7170A automatic biochemical analyzer.4. In-stent restenosis is judged by dynamic volume CT:>6 months after coronary artery stenting, the stent frame smoothness, stent diameter, stent lumen density, blood vessel condition of proximal and distal stent, location and severity of ISR were observed by the 320 row dynamic volume CT. The evaluation criteria of ISR:the diameter of vascular stent segment was measured>50%, then was diagnosed as ISR.5. Statistical methods:The statistical analysis was performed with SPSS software, version 13.0. At first normality and homogeneity of variance test was performed. The data showed as normal distribution were presented as mean±standard deviation (x±s) or percentage (%).In measurement data comparison between the two groups was evaluated by t-test and multiple groups were analyzed with analysis of variance. In enumeration data comparison between the two groups was evaluated by Chi-square test, when T<5 using Fisher exact test. Kaplan-Meier was performed on survival analysis. A two-tailed p<0.05 was considered significant. Tables and charts were used for descriptive statistics.Result1. The comparison of basic clinical data and pre-operation blood lipid,pre-operation(TC,TG,LDL-C,HDL-C),APN,ET-1,eNOS,hs-CRP,MMP-9,MCP-1 showed no significant difference in two groups of patients(P>0.05).2. The comparison of patients in Rosuvastatin group on blood lipid (TC,TG,LDL-C,HDL-C),plasma adiponectin,ET-1,eNOS,hs-CRP,MMP-9,MCP-1 before and after operating:①Compared to preoperative baseline values, the level of TC, TG and LDL-C was decreased gradually the first month, the third month, the sixth month after intervention. It showed significant difference (p<0.05). Blood HDL-C was increased gradually after intervention. Compared to preintervention it showed significant difference(p<0.05).②Plasma APN one day after PCI treatment was lower than the preoperation, that was showed statistically significant (p<0.01). Plasma APN levels were gradually increased after the first month, the third month,the sixth month, and the difference was significant (p<0.01).③Plasma ET-1 concentration was significantly higher first day after intervention than before in two groups. It showed significant difference (p<0.01). Plasma ET-1 concentration was significantly lower first month, third month, sixth month after intervention compared to first day after PCI. It showed significant difference (p<0.01). Plasma concentration was significantly lower first day after intervention than before in two groups. It showed significant difference (p<0.01). Plasma eNOS concentration was significantly higher first month, third month, sixth month after intervention compared to first day after PCI. It showed significant difference (p<0.01).④Plasma hs-CRP concentration were significantly higher first day after intervention than before in two groups. It showed significant difference (p<0.01). Plasma hs-CRP concentration was significantly lower first month, third month, sixth month after intervention compared to the first day after PCI. It showed significant difference (p<0.01).⑤Plasma MMP-9& MCP-1 concentration were significantly higher first day after intervention than before in two groups. It showed significant difference (p<0.01). Plasma MMP-9& MCP-1 concentration was significantly lower first month, third month, sixth month after intervention compared to first day after PCI. It showed significant difference (p<0.01).3. The comparison of patients in control group on blood lipid (TC,TG,LDL-C,HDL-C),plasma adiponectin,ET-1,eNOS,hs-CRP. MMP-9,MCP-1 before and after operating:①The level of TC,TG,LDL-C,HDL-C was no change the first month, the third month, the sixth month after intervention than preintervention. It showed significant difference(p<0.05).②Plasma APN one day after PCI treatment was lower than the preoperation, that was showed statistically significant (p<0.01). Plasma APN levels were gradually increased after the first month, the third month,the sixth month, and the difference was significant (p<0.01).③Plasma ET-1 concentration was significantly higher first day after intervention than before in two groups. It showed significant difference (p<0.01). Plasma ET-1 concentration was significantly lower first month, third month, sixth month after intervention compared to first day after PCI. It showed significant difference (p<0.01). Plasma concentration was significantly lower first day after intervention than before in two groups. It showed significant difference (p<0.01). Plasma eNOS concentration was significantly higher first month, third month, sixth month after intervention compared to first day after PCI. It showed significant difference (p<0.01).④Plasma hs-CRP concentration were significantly higher first day after intervention than before in two groups. It showed significant difference (p<0.01). Plasma hs-CRP concentration was significantly lower first month, third month, sixth month after intervention compared to the first day after PCI. It showed significant difference (p<0.01).⑤Plasma MMP-9& MCP-1 concentration were significantly higher first day after intervention than before in two groups. It showed significant difference (p<0.01). Plasma MMP-9& MCP-1 concentration was significantly lower the first month, the third month, the sixth month after intervention compared to the first day after PCI. It showed significant difference (p<0.01). 4. The comparison of in two groups on blood lipid (TC,TG,LDL-C,HDL-C),plasma APN,ET-1,eNOS,hs-CRP,MMP-9,MCP-1 after operating:after the first month, the third month, the sixth month blood TC,TG,LDL-C were significantly lower Rosuvastatin group compared to control group. It showed significant difference (p<0.05), and plasma blood hs-CRP,MMP-9,MCP-1 were significantly lower Rosuvastatin group compared to control group. It showed significant difference (p<0.01). After the first month, the third month plasma ET-1 was significantly lower Rosuvastatin group compared to control group. It showed significant difference (p<0.01). After the sixth month plasma ET-1 was not lower Rosuvastatin group compared to control group. It showed no significant difference (p>0.05). After the first month, the third month, the sixth month plasma APN& eNOS were significantly higher Rosuvastatin group compared to control group. It showed significant difference (p<0.01).5. Major adverse cardiac events in two groups were occurred nine cases, 2 cases in rosuvastatin group,7 cases in control group. Among the rosuvastatin group there were 2 cases of unstable angina.Among the control group there were 7 cases of unstable angina. The two groups showed the significant statistically difference(p<0.05).6.6 to 12 months after coronary artery stenting, the stent frame smoothness, stent diameter, stent lumen density, blood vessel condition of proximal and distal stent, location and severity of ISR were observed by the 320 row dynamic volume CT. Among the Rosuvastatin group there were 16 cases. Among the control group there were 14 cases. According to the evaluation criteria of ISR, there is no restenosis in Rosuvastatin treated group, and 2 cases of restenosis in control group, that showed the significant statistically difference(p<0.05). The stent frame smoothness,blood vessel condition of proximal and distal stent in two groups showed no statistical difference(p>0.05). Comparison of stent diameter and stent lumen density indicated Rosuvastatin group was less than control group in calcified plaque within stent, and was larger than control group in stent diameter, which showed the significant statistically difference(p<0.05).Conclusion1. The TC,LDL-C,TG was significantly decreased, and HDC-C was increased after using Rosuvastatin in the patients of coronary stent implantation. It showed that Rosuvastatin has better security in the patients of coronary stent implantation.2. Rosuvastatin can increase plasma APN level in the patients of coronary stent implantation, improve impaired vascular endothelial function, inhibit the excessive proliferation of smooth muscle cells and vascular inflammatory response.3. The effect of Rosuvastatin which decreased the rate of adverse cardiac events was initially observed.4. The rate of coronary artery restenosis was decreased 6-12 months after coronary stent implantation by using Rosuvastatin, which was observed by 320 row dynamic volume CT.It shows that Rosuvastatin can decrease the rate of the restenosis after coronary stenting.5. The study shows that Rosuvastatin can prevent and delay the occurrence of ISR after coronary stent implantation.
|
PDF Full Text Request