碱性磷酸酶联合血管内超声对ACS患者经皮冠状动脉介入治疗后非靶血管病变进展的预测价值  

Predictive Value of Alkaline Phosphatase Combined with Intravascular Ultrasound in the Progression of Non-Target Vascular Diseases in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention

作　　者：姬劲锐 陈文山 徐平 刘洋[1] 葛迎辉 刘恒亮 JI Jingrui;CHEN Wenshan;XU Ping;LIU Yang;GE Yinghui;LIU Hengliang(Department of Cardiology,People′s Hospital,Henan University of Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学人民医院心血管内科二病区,郑州450000

出　　处：《岭南心血管病杂志》2023年第3期255-259,共5页South China Journal of Cardiovascular Diseases

基　　金：河南省医学科技攻关计划项目(项目编号:LHGJ20200678);河南省科技攻关项目(项目编号:222102310345)。

摘　　要：目的探讨碱性磷酸酶(alkaline phosphatase,ALP)联合血管内超声(intravenous ultrasound,IVUS)对急性冠状动脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后非靶血管病变进展的预测价值。方法选择2017年6月至2019年7月在河南中医药大学人民医院心内科收治住院并行PCI治疗的ACS患者241例为研究对象,根据随访1年是否出现非靶血管再狭窄分为再狭窄组(28例)和对照组(213例),对比分析两组患者间观察指标的差异。结果ALP、病变长度、IVUS显示钙化、IVUS钙化分类、IVUS钙化长度、钙化弧度、钙化特征评分、最小管腔面积(minimum lumen area,MLA)≤4 mm^(2)、斑块负荷(plaque load,PB)>70%均为PCI治疗后非靶血管斑块进展的危险因素(P<0.05)。钙化特征评分预测PCI治疗后非靶血管斑块进展灵敏度为69.44%,特异度为75.81%,曲线下面积为0.718(95%CI:0.639~0.796,P=0.005);ALP预测PCI治疗后非靶血管斑块进展灵敏度为61.11%,特异度为77.42%,曲线下面积为0.701(95%CI:0.620~0.782,P=0.013);两者联合检测的灵敏度为88.88%,特异度为70.96%,曲线下面积为0.872(95%CI:0.835~0.909,P=0.000),其灵敏度高于单项检测指标(P<0.05)。结论ALP作为预测钙化特征及斑块稳定性的潜在标志物与冠状动脉IVUS钙化联合检测对PCI治疗后非靶血管斑块进展评估具有重要价值。Objectives To investigate the predictive value of alkaline phosphatase(ALP)combined with intravascular ultrasound(IVUS)in the progression of non-target vascular disease in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods Totally 241 patients with ACS who were admitted to hospital and underwent PCI in Henan University of Chinese Medicine People′s Hospital from June 2017 to July 2019 were selected as the subjects.According to whether there were non target vessel restenosis in the follow-up period,they were divided into restenosis group(n=28)and control group(n=213),and the differences between the two groups were analyzed.Results ALP,lesion length,IVUS calcification,IVUS calcification classifciation,IVUS calcification length,calcification arc,calcification characteristci score,minimum lumen area(MLA)≤4 mm2,plaque load(PB)>70%were all risk factors for the progression of nontarget vascular plaque after PCI(P<0.05).The sensitivity of nontarget vascular plaque development was 69.44%and specificity was 75.81%.The area under the curve(AUC)was 0.718(95%CI:0.639-0.796,P=0.005).ALP predicted the sensitivity of non target vascular plaque progression after PCI was 61.11%,specificity was 77.42%,and AUC was 0.701(95%CI:0.620-0.782,P=0.013).The sensitivity of the two joint tests was 88.88%,the specificity was 70.96%,and AUC was 0.872(95%CI:0.835-0.909,P=0.000),and the sensitivity was higher than that of single detection index(P<0.05).Conclusions ALP as a potential marker for predicting calcification characteristics and plaque stability,combined with the detection of coronary artery IVUS calcification has a great value in the evaluation of the progression of non-target vascular plaque in patients with ACS after PCI.

关 键 词：冠状动脉疾病 碱性磷酸酶 血管内超声 非靶血管 

分 类 号：R541.4[医药卫生—心血管疾病]