CAJ | 학술논문

目的：探讨雷公藤内酯醇药物洗脱支架抑制再狭窄的机制。方法18只健康国内西藏小型猪随机分为不锈钢裸支架组（BMS）、雷帕霉素洗脱支架组（SES）、雷公藤内酯醇洗脱支架（TES）100μg组，每组各6只猪，术后7 d和28 d复查冠状动脉造影后放血处死动物，分离冠状动脉支架血管段固定。测定冠状动脉外弹力膜层横断面积、支架上平均内膜厚度、支架间平均内膜厚度，观察血管平滑肌细胞的移行、增殖及内膜厚度变化，计算血管损伤积分。用免疫组织化学方法检测冠状动脉组织中基质金属蛋白酶2（MMP2）和细胞分裂周期基因2（CDC2）的蛋白表达，并进行半定量分析。结果支架植入导致的冠状动脉血管损伤积分各组均差异无统计学意义（P＝0．457）。支架植入后7 d，BMS组可见增生内膜几乎全部包绕支架撑杆，SES组、TES 100μg组支架撑杆两侧可见内膜增生，管腔面支架裸露。支架植入28 d后各组血管内膜完全内皮化，BMS组支架上内膜厚度、支架间内膜膜厚度均较TES 100μg、SES组厚，差异有统计学意义（ P＜0．01）。支架植入后7 d和28 d，免疫组织化学分析MMP-2、CDC2激酶在BMS组中强表达，TES 100μg和SES组弱表达，平均灰度值经统计学比较，差异有统计学意义（ P＜0．01）。结论：雷公藤内酯醇洗脱支架100μg组剂量能很好的抑制血管内膜过度增生，预防再狭窄。
목적：탐토뢰공등내지순약물세탈지가억제재협착적궤제。방법18지건강국내서장소형저수궤분위불수강라지가조（BMS）、뢰파매소세탈지가조（SES）、뢰공등내지순세탈지가（TES）100μg조，매조각6지저，술후7 d화28 d복사관상동맥조영후방혈처사동물，분리관상동맥지가혈관단고정。측정관상동맥외탄력막층횡단면적、지가상평균내막후도、지가간평균내막후도，관찰혈관평활기세포적이행、증식급내막후도변화，계산혈관손상적분。용면역조직화학방법검측관상동맥조직중기질금속단백매2（MMP2）화세포분렬주기기인2（CDC2）적단백표체，병진행반정량분석。결과지가식입도치적관상동맥혈관손상적분각조균차이무통계학의의（P＝0．457）。지가식입후7 d，BMS조가견증생내막궤호전부포요지가탱간，SES조、TES 100μg조지가탱간량측가견내막증생，관강면지가라로。지가식입28 d후각조혈관내막완전내피화，BMS조지가상내막후도、지가간내막막후도균교TES 100μg、SES조후，차이유통계학의의（ P＜0．01）。지가식입후7 d화28 d，면역조직화학분석MMP-2、CDC2격매재BMS조중강표체，TES 100μg화SES조약표체，평균회도치경통계학비교，차이유통계학의의（ P＜0．01）。결론：뢰공등내지순세탈지가100μg조제량능흔호적억제혈관내막과도증생，예방재협착。
Objective To reveal the mechanism of in-stent restenosis and provide theoretical fundamentals of clinical application of triptolide-eluting stent .Methods 18 tibet mini-pigs were randomly divided into 3 groups:bare metal stent group,sirolimus-eluting group and triptolide-eluting 100 μg group.At the 7th or 28th day,coronary angiography was investigated before animals were sacrificed and the coronary arteries perfusion fixed .The stented coro-nary arteries were sected and the injury score ,neointimal thickness above the struts and between the struts of stents were analyzed,The immunohistochemical staining was used to determine the protein expression of CDC 2 and MMP-2. Quantitative expression of CDC 2 and MMP-2 were analyzed by quantify the protein expression of CDC 2 and MMP-2 according to the grey of dye .Results There was no significant difference in the injury scores among the 3 groups (P=0.457)To compare the BMS group with SES、100 μg triptolide-eluting stent groups,there was a significant difference in neointimal thickness above the struts and between the struts .The complete re-endothelialization were ob-served in all groups at the 28th day.After stent implantation 7 days and 28 days, immunohistochemical analysis showed that the intensity of MMP-2 and CDC2 expressions in BMS group was higher than that in 100 μg and SES group(P<0.01).Conclusions 100 μg troptolide eluting-stent group could inhibit neointimal hyperplasia in mini-pig models .