冠状动脉慢性完全闭塞病变介入治疗前后的血管抑素水平改变与远期左室收缩功能改善的相关性研究  

Relationship between Changes of Angiostatin Levels before and after Percutaneous Coronary Intervention and Long-term Improvement of Left Ventricular Systolic Function in Patients with Coronary Chronic Total Occlusion

作　　者：陈章炜 卢淡泊 武渊 任道元 夏妍 陈傲 姚康 马剑英 钱菊英 葛均波 CHEN Zhang-wei;LU Dan-bo;WU Yuan;REN Dao-yuan;XIA Yan;CHEN Ao;YAO Kang;MA Jian-ying;QIAN Ju-ving;GE Jun-bo(Department of Cardiology,Zhongshan Hospital,Fudan University,National Clinical Research Center for Interventional Medicine,Shanghai Institute of Cardiovascular Diseases,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心内科,国家放射与治疗临床医学研究中心,上海市心血管病研究所,上海市200032

出　　处：《中国分子心脏病学杂志》2021年第4期4041-4044,共4页Molecular Cardiology of China

基　　金：国家自然科学基金(81870267,1970295,81521001);上海市卫生系统优青(2017YQ057);科技部重点研发计划(2019YFC0840601);上海申康发展项目(SHDC12019104);VG基金临床研究项目(2017-CCA-VG-036);心馨-默克基金项目(Xinxin-merck-fund-051)。

摘　　要：目的冠状动脉慢性完全闭塞(chronic total occlusion,CTO)病变严重影响患者的心肌血供和临床预后,开通闭塞血管可以减少某些特定患者的不良心脏事件,改善左室收缩功能。然而对于CTO介入术后的患者缺乏能够预测远期左室收缩功能改善与否的特异性标志物。方法入组复旦大学附属中山医院冠状动脉CTO病变的患者,应用1.5T心脏磁共振扫描明确术前及术后6个月的左室射血分数(left ventricular ejection fraction,LVEF)改善情况,同时ELISA法检测术前和术后24小时的外周血血管抑素水平,结合多因素Logistic回归分析血管抑素水平改变对远期LVEF改善的预测价值。结果2014年1月至6月期间共26例CTO病变患者完成6个月的磁共振随访,平均年龄56岁,术后6个月的LVEF显著高于术前值[(61.1±8.0)%比(56.9±6.7)%,P=0.046]。其中,LVEF改善超过10%的8人,LVEF改善未达10%的18人。LVEF改善组的术后血管抑素水平较术前显著升高[(307.9±116.4)ng/ml比(161.2±82.3)ng/ml,P<0.01],而在LVEF未改善组则无差异。多因素Logistic回归,同时控制年龄、eGFR、NT-pro-BNP后,手术前后血管抑素差值仍旧是LVEF改善的独立预测因素(OR=1.015,95%CI=1.000~1.031,P=0.045)。结论冠状动脉CTO病变血管介入术后心功能改善组患者血管抑素水平显著升高;手术前后的血管抑素差值与远期左室收缩功能改善独立相关。Objective Coronary chronic total occlusion(CTO)lesions seriously affect the myocardial perfusion and clinical prognosis of patients.Opening the occluded vessels can reduce adverse cardiac events and improve left ventricular systolic function in some specific patients.However,there is a lack of specific markers that can predict long-term LVEF improvement in patients after CTO intervention.Methods In patients with coronary CTO in our hospital,1.5 T cardiac magnetic resonance scanning was used to determine the left ventricular ejection fraction(LVEF)and the improvement of LVEF at 6 months after intervention.The levels of angiostatin in peripheral blood were measured by ELISA pre-intervention and 24 hours after.The predictive value of angiostatin pre-and after intervention for the improvement of long-term LVEF was analyzed in combination with multivariate logistic regression.Results A total of 26 patients with coronary CTO lesions completed the 6-month MRI follow-up from January to June in 2014.The mean age was 56 years.The LVEF at 6 months after intervention was significantly higher than that before intervention(61.1%±8.0%vs 56.9%±6.7%,P=0.046).8 of these patients had LVEF improvement of more than 10%and 18 had LVEF improvement of less than 10%.Compared with pre-intervention,the post-intervention angiostatin levels were significantly increased in the LVEF improvement group(307.9±116.4 vs 161.2±82.3 ng/ml,P<0.01),but no change in the LVEF non-improvement group.After multivariate Logistic regression,while controlling for age,eGFR,and NT-pro-BNP,the difference of angiostatin between the post-intervention and pre-intervention remained an independent predictor of improved LVEF(OR=1.015,95%CI=1.000-1.031,P=0.045).Conclusion Serum angiostatin levels were significantly increased after intervention for coronary CTO lesions in the LVEF improvement group,the post-intervention angiostatin change was independently associated with long-term left ventricular systolic function improvement.

关 键 词：冠状动脉慢性完全闭塞病变 血管抑素 心脏磁共振 左室射血分数 

分 类 号：R541.4[医药卫生—心血管疾病]