血浆Quaking和环氧合酶-2水平预测冠心病患者行经皮冠状动脉介入术后支架内再狭窄  

Levels of plasma Quaking and cyclooxygenase-2 predict in-stent restenosis in patients with coronary artery disease after percutaneous coronary intervention

作　　者：王萍[1] 匡圆圆 刘昱博 张银妆 高浩东 马琦琳[1] WANG Ping;KUANG Yuanyuan;LIU Yubo;ZHANG Yinzhuang;GAO Haodong;MA Qilin(Department of Cardiology,Xiangya Hospital,Central South University,National Clinical Research Center for Geriatric Disorders,Xiangya Hospital,Changsha 410008;Department of Cardiology,First Hospital of Changsha,Changsha 410005,China)

机构地区：[1]中南大学湘雅医院心血管内科,国家老年疾病临床医学研究中心(湘雅医院),长沙410008 [2]长沙市第一医院心内科,长沙410005

出　　处：《中南大学学报（医学版）》2022年第6期739-747,共9页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(81974026)。

摘　　要：目的:经皮冠状动脉介入术(percutaneous coronary intervention,PCI)是治疗冠心病的重要手段之一,支架植入术后发生的支架内再狭窄(in-stent restenosis,ISR)是影响冠心病患者PCI术后远期疗效及预后的重要因素。本研究旨在探讨血浆Quaking(QKI)、环氧合酶-2(cyclooxygenase-2,COX-2)水平与冠心病患者PCI术后ISR的相关性。方法:连续选取2019年9月至2020年9月在中南大学湘雅医院心血管内科行冠状动脉造影并行支架植入术的冠心病患者218例,选取同期在体检中心体检的与冠心病患者基线资料相匹配的35例个体作为对照组。入院后收集两组患者的临床资料,采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)测定血浆QKI、COX-2水平。术后12个月复查冠心病患者的冠状动脉造影,根据是否发生ISR将218例冠心病患者分为无再狭窄组(NISR组,n=160)与再狭窄组(ISR组,n=58)。比较NISR组与ISR组的一般资料及冠状动脉临床指标,采用多因素logistic回归分析ISR的影响因素。记录1年内主要不良心血管事件(major adverse cardiovascular events,MACE)发生情况,并据此将58例PCI术后ISR患者分为未发生MACE组(34例)与发生MACE组(24例),比较两组的血浆QKI、COX-2水平,采用受试者操作特征(receiver operating characteristic,ROC)曲线探究血浆QKI、COX-2水平对PCI术后ISR及MACE的诊断价值。结果:与对照组相比,冠心病组COX-2及QKI水平明显下降(均P<0.001)。与NISR组相比,ISR组超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、糖化血红蛋白(glycosylated hemoglobin,HbAlc)显著升高(均P<0.001),COX-2及QKI水平明显下降(均P<0.001)。血浆COX-2与hs-CRP水平呈负相关(r=-0.385,P=0.003)。多因素logistic回归分析发现血浆高水平QKI、COX-2是冠心病患者PCI术后ISR的保护因素,高水平hs-CRP是危险因素。ROC曲线分析显示:血浆QKI诊断冠心病患者PCI术后ISR的灵敏度为77.5%,特异度为65.5%;血浆COX-2Objective:Percutaneous coronary intervention(PCI)is one of the important methods for the treatment of coronary artery disease(CAD).In-sent restenosis(ISR)after PCI for patients suffered from CAD is considered to be an essential factor affecting long-term outcomes and prognosis of this disease.This study aims to investigate the correlation between plasma Quaking(QKI)and cyclooxygenase-2(COX-2)levels and ISR in patients with CAD.Methods:A total of 218 consecutive CAD patients who underwent coronary angiography and coronary arterial stenting from September 2019 to September 2020 in the Department of Cardiology of Xiangya Hospital of Central South University were enrolled in this study,and 35 matched individuals from the physical examination center were served as a control group.After admission,clinical data of these 2 groups were collected.Plasma QKI and COX-2 levels were measured by enzyme linked immunosorbent assay(ELISA).Follow-up angiography was performed 12 months after PCI.CAD patients were divided into a NISR group(n=160)and an ISR group(n=58)according to the occurrence of ISR based on the coronary angiography.The clinical data,coronary angiography,and stent features between the NISR group and the ISR group were compared,and multivariate logistic regression was used to explore the factors influencing ISR.The occurrence of major adverse cardiovascular events(MACE)1 year after operation was recorded.Fifty-eight patients with ISR were divided into an MACE group(n=24)and a non-MACE group(n=34),classified according to the occurrence of MACE,and the plasma levels of QKI and COX-2were compared between the 2 groups.Receiver operating characteristic(ROC)curves were utilized to analyze the diagnostic value of plamsa levels of QKI and COX-2 for ISR and MACE occurrences in patients after PCI.Results:Compared with control group,plasma levels of QKI and COX-2 in the CAD group decreased significantly(all P<0.001).Compared with the NISR group,the plasma levels of QKI and COX-2 also decreased obviously in the ISR group(all P<

关 键 词：冠心病 经皮冠状动脉介入治疗 Quaking 环氧合酶-2 支架内再狭窄 主要不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]