心外膜脂肪组织容积及炎症因子对支架置入术后支架内再狭窄的预测价值  

The predictive value of epicardial adipose tissue and inflammatory factors for in-stent restenosis

作　　者：周庆娜 林文华[1] 敬锐[1] 刘菁晶[1] 史宏岩[1] 杨瑞飞[1] 高鹏 张岩[1] Zhou Qingna;Lin Wenhua;Jing Rui;Liu Jingjing;Shi Hongyan;Yang Ruifei;Gao Peng;Zhang Yan(Clinical College of Cardiology,Tianjin Medial University and TEDA International Cardiovascular Hospital,Tianjin 300070,China)

机构地区：[1]天津医科大学心血管临床学院,泰达国际心血管病医院内一科,天津300070

出　　处：《中华医学杂志》2019年第47期3732-3736,共5页National Medical Journal of China

基　　金：天津市滨海新区卫生局科技项目(2013BWKL002)。

摘　　要：目的探讨心外膜脂肪组织容积(EATV)及炎症因子对冠心病患者经皮冠状动脉支架置入术(PCI)后支架内再狭窄(ISR)的预测价值。方法入选2016年11月至2017年10月在泰达国际心血管病医院内一科行药物洗脱支架置入术的冠心病患者407例,检测炎症因子高敏C-反应蛋白(hs-CRP),白细胞介素-6(IL-6)及肿瘤坏死因子-α(TNF-α)的水平,术前采用多螺旋CT(MSCT)测量EATV。根据术后1年内造影结果是否发生ISR分为ISR组(n=52)和N-ISR组(n=355)。分析EATV及炎症因子与冠心病患者PCI术后ISR的关系。结果两组在糖尿病病史、IL-6、TNF-α、EATV[(150±36)cm^3比(120±40)cm^3,P=0.001]、分叉病变、支架长度及Gensini评分方面差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示糖尿病、分叉病变、TNF-α、EATV及Gensini评分是ISR的危险因素。EATV对冠心病患者PCI术后ISR的AUC值为0.712,95%的可信区间(CI)0.648~0.776,P<0.001,最佳界值点为116.61 cm^3,其敏感度为86.5%,特异度为53.8%;TNF-α对冠心病患者PCI术后ISR的AUC值为0.752,95%CI 0.686~0.819,P<0.001,最佳界值点为138.40µg/L,其敏感度为67.3%,特异度为74.4%;IL-6对冠心病患者PCI术后ISR的AUC值为0.675,95%CI 0.584~0.766,P<0.001,最佳界值点为126.4µg/L,其敏感度为69.2%,特异度为70.1%。结论EATV、TNF-α及IL-6对PCI术后支架内再狭窄有一定预测价值,可以作为临床预测支架内再狭窄的指标。Objective To investigate the predictive value of epicardial adipose tissue volume(EATV)and inflammatory factors on in-stent restenosis(ISR)after percutaneous coronary implantation(PCI)in patients with coronary heart disease(CAD).Methods A total of 407 patients with CAD who were treated with drug-eluting stents in TEDA international cardiovascular disease hospital were enrolled from November 2016 to October 2017.Levels of inflammatory cytokines such as high sensitive c-reactive protein(Hs-CRP),interleukin-6(IL-6),and tumor necrosis factor(TNF-α)were detected.EATV was measured preoperatively by multi-sliced CT.Patients were divided into ISR group(n=52)and N-ISR group(n=355)according to ISR occurred within 1 year after procedure.The relationship between EATV and inflammatory factors and ISR after PCI was analyzed.Results The differences between ISR group(n=52)and N-ISR group(n=355)were statistically significant in terms of diabetes history,IL-6,TNF-α,EATV((150±36)cm^3vs(120±40)cm^3,P=0.001),bifurcation lesions,stent length and Gensini score(P<0.05).Multivariate Logistic regression analysis results showed that diabetes history,bifurcation lesions,TNF-α,EATV,and Gensini score were risk factors for in-stent restenosis.The area under the ROC curve(AUC)of EATV,TNF-α,and IL-6 in patients with CAD after PCI was 0.712,0.752 and 0.675(95%CI 0.648-0.776,0.686-0.819,0.584-0.766,respectively,all P<0.001),with a sensitivity of 86.5%,67.3%and 69.2%,a specificity of 53.8%,74.4%and 70.1%and a cut-off value of 116.61 cm^3,138.40µg/L and 126.4µg/L,respectively.Conclusion EATV,TNF-α,and IL-6 have certain predictive values for in-stent restenosis,and can be used as clinical indicators to predict in-stent restenosis.

关 键 词：心外膜脂肪组织 支架内再狭窄 炎症因子 

分 类 号：R54[医药卫生—心血管疾病]