外周血单核细胞NLRP3在冠状动脉支架术后再狭窄患者中的表达水平及临床意义  

Expression level and clinical significance of peripheral blood mononuclear cell NLRP3 in patients with postoperative in-stent restenosis

作　　者：徐为 罗浩 唐辉 XU Wei;LUO Hao;TNAG Hui(Department of Cardiovascular Medicine,Daping Hospital,Army Military Medical University,Chongqing 400042,China;Department of Cardiovascular Medicine,People′s Hospital of Shuangqiao Economic-Technological Development Zone,Chongqing 400999,China)

机构地区：[1]陆军军医大学大坪医院心血管内科,重庆400042 [2]重庆市双桥经济技术开发区人民医院心血管内科,重庆400999

出　　处：《国际检验医学杂志》2022年第24期2954-2957,2962,共5页International Journal of Laboratory Medicine

基　　金：重庆市科卫联合医学科研项目(2021MSXM020);重庆市大足区科技计划项目(DZKJ2017ACC1017)。

摘　　要：目的研究外周血单核细胞NOD样受体热蛋白结构域相关蛋白3(NLRP3)炎性小体在冠状动脉支架术后再狭窄(ISR)患者中的表达水平及临床意义。方法纳入215例成功接受冠状动脉内药物洗脱支架置入术并在术后10~12个月行冠状动脉造影复查的患者,根据是否存在ISR,分为ISR组(52例)和非ISR组(163例)。收集各组一般临床资料,采用反转录定量聚合酶链反应(qRT-PCR)检测各组单核细胞NLRP3 mRNA相对水平,分析ISR发生的独立危险因素,采用受试者工作特征(ROC)曲线评价NLRP3炎性小体对ISR的诊断价值。结果与非ISR组比较,ISR组患者基础疾病方面糖尿病、高脂血症的比例,以及急性冠脉综合征、冠状动脉病变支数≥2支、植入支架枚数≥2枚、植入后TIMI分级>2级的比例均明显升高(P<0.05);同时ISR组外周血单核细胞NLRP3 mRNA相对水平明显升高(P<0.05)。Logistic回归分析显示,患有糖尿病、植入支架枚数≥2枚、植入后TIMI分级≤2级及NLRP3 mRNA相对水平升高是ISR发生的独立危险因素(P<0.05)。ROC曲线分析显示,外周血单核细胞NLRP3 mRNA诊断ISR的曲线下面积为0.778(95%CI:0.677~0.878),灵敏度和特异度分别为77.27%和61.29%。结论ISR患者外周血单核细胞NLRP3水平明显升高,是ISR发生的独立危险因素,对评估ISR的发生具有一定临床价值。Objective To study the expression level and clinical significance of peripheral blood mononuclear cell NOD-like receptor thermal protein domain associated protein 3(NLRP3)inflammasome in the patients with postoperative in-stent restenosis(ISR).Methods A total of 215 patients with successful intracoronary drug-eluting stent implantation conducting coronary angiography reexamination in postoperative 10-12 months were included and divided into the ISR group(52 cases)and non-ISR group(163 cases)according to whether existing the ISR.The general clinical data of each group were collected and the NLRP3 mRNA relative level of mononuclear cell in each group was detected by qRT-PCR.The independent risk factors for ISR formation were analyzed,and receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of NLRP3 inflammasome in ISR.Results Compared with the non-ISR group,the proportion of diabetes and hyperlipidemia in the aspect of the basic diseases,proportion of acute coronary syndromes,number of coronary artery lesions(≥2),number of implanted stents(≥2)and proportion of TIMI grade after implantation(>2)in the ISR group were significantly increased(P<0.05).At the same time,the relative level of peripheral blood mononuclear cell NLRP3 mRNA in the ISR group was significantly increased(P<0.05).The Logistic regression analysis showed that diabetes,number of implanted stents(≥2),TIMI grade(≤2)and increase of NLRP3 mRNA relativel level after implantation were the independent risk factors for ISR formation.The ROC curve analysis showed that the area under the curve(AUC)of peripheral blood mononuclear cell NLRP3 mRNA for diagnosing ISR was 0.778(95%CI:0.677-0.878),and the sensitivity and specificity were 77.27%and 61.29%,respectively.Conclusion The level of peripheral blood mononuclear cell NLRP3 in the patients with ISR is significantly increased,which is an independent risk factor for the ISR occurrence and has certain clinical value for evaluating the occurrence of ISR.

关 键 词：单核细胞 NOD样受体热蛋白结构域相关蛋白3 冠状动脉 支架术后再狭窄 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]