ACS患者PCI术前后血管内皮功能及炎症因子变化的临床意义  

Clinical significance of changes of vascular endothelial function and inflammatory factors in ACS patients before and after PCI

作　　者：尹锐 贾国渠 陈巍 张成伟 YIN Rui;JIA Guo-qu;CHEN Wei(Department of Cardiovascular Medicine,The Second Affiliated Hospital of Chengdu Medical College China National Nuclear Corporation 416 Hospital,Chengdu 610000,China)

机构地区：[1]成都医学院第二附属医院核工业四一六医院心血管内科,四川成都610000

出　　处：《中国实验诊断学》2021年第2期304-307,共4页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨急性冠状动脉综合症(ACS)患者经皮冠状动脉介入治疗(PCI)术前术后血管内皮功能及炎症因子变化的临床意义。方法选取2018年1月至2019年5月125例ACS患者为病例组,63例无ACS病史的健康人群为对照组。检测对照组以及病例组PCI术前、术后1个月、2个月、3个月时的血浆内皮素-1(ET-1)、一氧化氮(NO)、反应性充血后肱动脉内径变化百分率(FMD)、血清白细胞介素-6(IL-6)、IL-8、肿瘤坏死因子-α(TNF-α)。结果术前病例组的血浆ET-1水平高于对照组(P<0.05),血浆NO水平低于对照组(P<0.05),FMD值小于对照组(P<0.05)。病例组术后1个月、术后2个月、术后3个月时的血浆ET-1水平均低于术前(P<0.05),血浆NO水平均高于术前(P<0.05),FMD值均大于术前(P<0.05)。术前病例组的血清IL-6、IL-8、TNF-α水平高于对照组(P<0.05)。病例组术后1个月、术后2个月、术后3个月时的血清IL-6、IL-8、TNF-α水平低于术前(P<0.05)。患者PCI术后心血管不良事件与术前及术后3个月时的血浆ET-1水平、血清IL-6、IL-8、TNF-α水平呈正相关(P<0.05),与血浆NO水平、FMD值呈负相关(P<0.05)。PCI术前ET-1、NO、FMD值、IL-6、IL-8、TNF-α预测患者PCI术后心血管不良事件的灵敏度为87.50%、91.67%、83.33%、91.67%、91.67%、91.67%,特异度为69.31%、76.24%、76.24%、71.29%、68.32%、77.23%。结论ACS患者血管内皮功能指标ET-1、NO、FMD以及炎症因子IL-6、IL-8、TNF-α变化与PCI治疗预后密切相关,对预测PCI术后心血管不良事件有较高价值。Objective The study aims to investigate the clinical significance of changes of vascular endothelial function and inflammatory factors in patients with acute coronary syndrome(ACS)before and after percutaneous coronary intervention(PCI).Methods Between January 2018 and May 2019,125 ACS patients(case group)and 63 healthy subjects(control group)were enrolled in this study.Plasma endothelin-1(ET-1),nitric oxide(NO),flow-mediated diameter(FMD),serum interleukin-6(IL-6),IL-8,tumor necrosis factor-α(TNF-α)were detected before and after operation.Results Before operation,plasma ET-1 level was higher,plasma NO level was lower,and FMD was smaller in the case group than in the control group(P<0.05).At 1 month,2 months,and 3 months after operation,plasma ET-1 levels in the case group decreased(P<0.05),while plasma NO levels and FMD increased(P<0.05).Before operation,serum levels of IL-6,IL-8 and TNF-αwere higher in the case group than in the control group(P<0.05),which decreased at1 month,2 months,and 3 months after operation(P<0.05).Adverse cardiovascular events after PCI were positively correlated with plasma ET-1 levels,serum IL-6,IL-8,and TNF-αlevels before operation and at 3 months after operation(P<0.05),but were negatively correlated with plasma NO levels and FMD(P<0.05).The sensitivity of ET-1,NO,FMD,IL-6,IL-8,and TNF-αbefore PCI in predicting adverse cardiovascular events after PCI was 87.50%,91.67%,83.33%,91.67%,91.67%,and 91.67%.The specificity was 69.31%,76.24%,76.24%,71.29%,68.32%,and77.23%,respectively.Conclusion Changes of vascular endothelial function indexes ET-1,NO,FMD and inflammatory factors IL-6,IL-8,TNF-αin ACS patients are closely related to the prognosis of PCI,suggesting that the above indexes have high value in predicting adverse cardiovascular events after PCI.

关 键 词：急性冠状动脉综合症 经皮冠状动脉介入治疗 血管内皮损伤 炎症因子 心血管不良事件 

分 类 号：R543.3[医药卫生—心血管疾病]