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目的应用血管内超声(IVUS)观测口服雷帕霉素抑制支架内再狭窄的作用。方法通过球囊损伤腹主动脉和高脂(1%胆固醇)饲料喂养雄性新西兰纯种兔8周,然后将其分为对照组、口服雷帕霉素组、裸支架组、裸支架+口服雷帕霉素组和雷帕霉素药物涂层支架组,每组8只。口服雷帕霉素每天0.5 mg/kg或支架干预4周。检测动脉粥样硬化造模前后及干预前后的血脂指标,应用IVUS检测各组实验兔支架置入前后及用药前后腹主动脉病变部位管腔最小直径(MLD)、血管外弹力膜面积(EEMA)、管腔面积(LA)、斑块面积(PA),并计算管腔丢失、斑块负荷(PB)、斑块的偏心指数(EI)及血管的重构指数(RI)。通过比较各组IVUS指标,明确口服雷帕霉素抑制支架内再狭窄的作用。结果 与对照组及裸支架组比较,口服雷帕霉素组、裸支架+口服雷帕霉素组以及雷帕霉素涂层支架组的血脂指标未见明显降低。口服雷帕霉素组、裸支架+雷帕霉素组、雷帕霉素药物支架组的PA、PB均明显小于对照组和裸支架组(P均<0.01);裸支架+雷帕霉素组、雷帕霉素药物支架组的MLD明显高于裸支架组,管腔丢失明显小于裸支架组(P均<0.05),而裸支架+雷帕霉素组、雷帕霉素药物支架组未见明显差异。结论 口服雷帕霉素能够抑制斑块生长、降低支架内再狭窄,口服雷帕霉素配合裸支架与雷帕霉素药物支架的作用相似。
Objective To observe the effect of oral rapamycin on in-stent restenosis by intravascular ultrasound (IVUS). Methods Male New Zealand purebred rabbits were fed with balloon injury of abdominal aorta and high fat diet (1% cholesterol) for 8 weeks, then divided into control group, oral rapamycin group, bare stent group, bare stent + oral thunder Rapamycin group and drug-eluting stent group, 8 rats in each group. Oral rapamycin 0.5 mg / kg per day or stent intervention for 4 weeks. Serum lipids were measured before and after atherosclerosis and before and after atherosclerosis. IVUS was used to detect the minimum diameter of tunnel (MLD), the area of extravascular elastic membrane (EEMA) before and after the stent implantation, , Luminal area (LA) and plaque area (PA). The loss of lumen, plaque load (PB), plaque eccentricity index (EI) and vascular remodeling index (RI) were calculated. By comparing the IVUS index of each group, the effect of oral administration of rapamycin on in-stent restenosis was clarified. Results Compared with the control group and the bare stent group, there was no significant difference in the lipids between oral rapamycin group, bare stent + oral rapamycin group and rapamycin-coated stent group. PA and PB in oral rapamycin group, bare stent + rapamycin group and rapamycin stent group were significantly lower than those in control group and bare stent group (all P <0.01); bare stent + rapamycin Group, the rapamycin scaffold group had significantly higher MLD than that of the bare scaffold group, and the luminal loss was significantly smaller than that of the bare scaffold group (all P <0.05), while the bare scaffold + rapamycin group and the rapamycin scaffold group No obvious difference. Conclusion Oral rapamycin can inhibit plaque growth and reduce in-stent restenosis. The oral administration of rapamycin with bare scaffolds is similar to that of rapamycin scaffolds.