血清补体C1q与经皮冠状动脉药物洗脱支架植入后支架内再狭窄相关性分析  

Correlation between serum complement 1q and in-stent restenosis after percutaneous coronary implantation of drug eluting stent

作　　者：田晋帆 宋现涛[1] 贺毅 张闽[1] 周渊[1] 张明多[1] 薛玉国[1] 张东凤[1] 南楠[1] 杨雪瑶 雍婧雯 邢浩然 赵馨 Tian Jinfan;Song Xiantao;He Yi;Zhang Min;Zhou Yuan;Zhang Mingduo;Xue Yuguo;Zhang Dongfeng;Nan Nan;Yang Xueyao;Yong Jingwen;Xing Haoran;Zhao Xin(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;不详)

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029 [2]首都医科大学附属北京友谊医院放射科,北京100050

出　　处：《中国循证心血管医学杂志》2021年第2期162-165,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：国家然科学基金(81671650、81971569、81670324);2018年“微血管疾病创新基金(2018-CCA-CMVD-01)”;首都卫生发展专项(2018-2-2063);2018年“北京市优秀人才骨干”(2018000021469G241);2020年“北京市教育委员会科技计划项目”(KM202010025016)。

摘　　要：目的目前经皮冠状动脉(冠脉)药物洗脱支架治疗降低了急性冠脉综合征患者的死亡率,然而冠脉支架内再狭窄(ISR)仍是临床中亟待解决的问题。分析支架内再狭窄的相关因素是减少其发生的关键。方法回顾分析于2016年1月至2019年5月于北京安贞医院住院复查冠脉造影的连续病例201例,排除合并感染、支气管哮喘,风湿免疫性疾病、支架植入术后小于12个月的患者(16例),ISR患者(88例,ISR组)以及非ISR患者(97例,非ISR组)纳入研究。比较2组临床特征,血液生化指标差异。受试者工作特征曲线(ROC曲线)及多因素Logistic回归分析血清学指标与支架内再狭窄的相关性。结果ISR组患者血清三酰甘油[(1.55±1.02)vs.(1.23±0.57)mmol/L]、血清小而密低密度脂蛋白[(0.68±0.30)vs.(0.58±0.23)mmol/L]、血清补体C1q[(184.96±37.22)vs.(157.98±20.93)mmol/L]、花生四烯酸介导的血小板聚集率[(11.85±16.79)vs.(6.94±2.53)%]显著高于非ISR组,差异均具有统计学意义。ROC曲线显示血清补体C1q与ISR呈正相关,其诊断ISR的曲线下面积为0.738,P<0.01。以168.95 mg/L为血清补体C1q截点值,其诊断ISR的灵敏度为65.2%,特异度为75%。多因素Logistic回归分析显示,血清补体C1q>168.95 mg/L与ISR呈正相关(OR=4.62,95%CI:2.05~10.40,P<0.01)。结论血清补体C1q水平与经皮冠脉药物洗脱支架内再狭窄密切相关,是支架内再狭窄的诊断因素之一。血清补体C1q是经皮冠脉药物洗脱支架内再狭窄防治的潜在靶点,其在冠脉支架内再狭窄中的作用机制有待进一步研究。Objective To analyze the factors related to in-stent restenosis(ISR)after percutaneous coronary implantation of drug eluting stent(DES).Methods The patients(n=201)undergone coronary angiography reexamination were retrospectively analyzed in Beijing Anzhen Hospital from Jan.2016 to May 2019,and those with infection,bronchial asthma,rheumatic autoimmune diseases and stent implantation within 12 months(n=16)were excluded.ISR patients(n=88,ISR group)and non-ISR patients(n=97,non-ISR group)were chosen into the study.The difference in clinical characteristics and blood biochemical indexes were compared between 2 groups.The correlation between serum indexes and ISR was analyzed by using ROC curve and multi-factor Logistic regression analysis.Results The levels of triglyceride[(1.55±1.02)vs.(1.23±0.57)mmol/L],serum small-density lowdensity lipoprotein-cholesterol[(0.68±0.30)vs.(0.58±0.23)mmol/L],serum complement 1q[C1q,(184.96±37.22)vs.(157.98±20.93)mmol/L]and arachidonic acid-mediated platelet aggregation rate[(11.85±16.79)vs.(6.94±2.53)%]were significantly higher in ISR group than those in non-ISR group with statistical significance.ROC curve analysis showed that serum C1q was positively correlated to ISR,and its AUC for diagnosing ISR was 0.738(P<0.01).Taken 168.95 mg/L as C1q cut-off value,the sensitivity of C1q was 65.2%and specificity was 75%in ISR diagnosis.The results of multi-factor Logistic regression analysis showed that C1q>168.95 mg/L was positively correlated to ISR(OR=4.62,95%CI:2.05~10.40,P<0.01).Conclusion The level of serum C1q is closely correlated to ISR after percutaneous coronary implantation of DES,which is one of diagnosis factors for ISR.C1q is a potential target for prevention and treatment of ISR after percutaneous coronary implantation of DES,and the mechanism needs further study.

关 键 词：支架内再狭窄 补体C1Q 平滑肌细胞增殖 经皮冠脉药物洗脱支架植入 

分 类 号：R816.2[医药卫生—放射医学]