冠心病PCI术后患者血液FIB,NLRP3和LECT-2水平表达与冠状动脉微血管疾病发生的相关性研究  

Correlation between Blood FIB, NLRP3 and LECT-2 Expression Levels andthe Development of Coronary Microvascular Disease in Patients withCoronary Artery Disease after PCI

作　　者：蒋红英 王依阳 赵慧 梁宸源 姜瑞嘉 任园园 陈亮 许百灵 程功[1] JIANG Hongying;WANG Yiyang;ZHAO Hui;LIANG Chenyuan;JIANG Ruijia;REN Yuanyuan;CHEN Liang;XU Bailing;CHENG Gong(Department of Cardiology,Shaanxi Provincial People’s Hospital,Xi’an 710068,China;Institute of Nuclear Science and Engineering-Columbia University of Missouri,U S A,Missouri MO 65211,USA)

机构地区：[1]陕西省人民医院心血管内科,西安710068 [2]美国密苏里哥伦比亚大学-核科学暨工程研究所,密苏里州MO 65211

出　　处：《现代检验医学杂志》2023年第6期35-41,共7页Journal of Modern Laboratory Medicine

基　　金：陕西省中医药管理局基金(2021-ZZ-ZY003):葛兰心宁软胶囊对冠心病PCI术后合并冠脉微循环障碍患者疗效研究;陕西省人民医院2022年科技人才支持计划资助项目(2022LJ-04):急性冠脉综合征PCI术后合并微循环功能障碍SPECT定量评估、炎症反应和氧化应激的作用及葛兰心宁的疗效研究。

摘　　要：目的 探究冠心病经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后患者血液纤维蛋白原(fibrinogen,FIB)、核苷酸结合寡聚化结构域样受体蛋白3(nucleotide-binding oligomerization domain-like receptor protein3,NLRP3)和白细胞衍生趋化因子2(leukocyte cell-derived chemotaxin 2,LECT-2)与冠状动脉微血管疾病(coronary microvascular disease,CMVD)发生的相关性。方法 收集2021年7月~2022年9月冠心病PCI术后仍有心肌缺血相关症状就诊于陕西省人民医院心内科的患者,冠状动脉造影或冠脉CT血管成像检查提示心外膜冠脉狭窄直径<50%,根据单电子发射计算机断层成像(single-photon emission computer tomography,SPECT)检查测定冠状动脉血流储备(coronary flow reserve,CFR),分为CMVD组(CFR<2.0,n=78)和对照组(CFR≥2.0,n=47)。检测血液FIB,血小板与淋巴细胞比值(platelet to lymphocyte ratio, PLR),糖化血红蛋白(HbA1c),NLRP3和LECT-2水平,分析其与冠心病PCI术后CMVD发生的相关性。绘制受试者工作特征(receiver operating characteristic,ROC)曲线,评价血液FIB,PLR,HbA1c,NLRP3和LECT-2对冠心病PCI术后CMVD发生的预测价值。结果 与对照组比较,CMVD组血液FIB(3.31±1.09g/L vs 2.83±0.77g/L),PLR[742.69(515.82,968.25) vs 642.23(482.28,767.54)],HbA1c[6.20%(5.70%,7.50%) vs 5.80%(5.50%,6.50%)],NLRP3[343.29(217.20,504.90)pg/ml vs 245.02(170.00,328.60)pg/ml]和LECT-2[23.24(14.92,27.24)ng/ml vs 17.85(10.30,26.41)ng/ml]表达水平均升高,差异有统计学意义(t=1.103,Z=-2.172,-2.213,-3.239,-2.592,均P<0.05)。多因素Logistic回归分析,血液FIB[OR(95%CI):4.213(1.481~11.981)]和NLRP3[OR(95%):1.004(1.000~1.007)]是冠心病PCI术后CMVD发生的独立危险因素(Waldχ^(2)=7.274,4.061,均P<0.05)。血液FIB和NLRP3对冠心病PCI术后CMVD发生的预测价值的ROC曲线下面积分别为0.648和0.679,二者联合诊断曲线下面积为0.712。结论 冠心病PCI术后患者血液FIB和NLRP3表达水平升高,与CMVD发生密切相关。血液FIB�Objective To investigate the association of bloodfibrinogen(FIB),nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)and leukocyte cell-derived chemotaxin 2(LECT-2)with the development of coronary microvascular disease(CMVD)in patients after percutaneous coronary intervention(PCI)for coronary artery disease.Methods From July 2021 to September 2022,the patients with symptoms related to myocardial ischemia after PCI for coronary artery disease were collected from the Department of Cardiology of Shaanxi Provincial People’s Hospital,and their coronary angiography or coronary CT angiography suggested epicardial coronary stenosis<50%in diameter.Single electron emission computed tomography(SPECT)was performed to determine coronary flow reserve(CFR).78 cases were divided into the CMVD group(CFR<2.0)and 47 cases in the control group(CFR≥2.0).Blood FIB,PLR,HbA1c,NLRP3 and LECT-2 levels were measured and their correlation with the occurrence of CMVD after PCI for coronary artery disease was analysed.To evaluate the predictive value of blood FIB,PLR,HbA1c,NLRP3 and LECT-2 on the occurrence of CMVD after coronary artery disease PCI,a receiver operating characteristic(ROC)curve was plotted.Results Compared to the control group,blood FIB(3.31±1.09g/L vs 2.83±0.77g/L),PLR[742.69(515.82,968.25)vs 642.23(482.28,767.54)],HbA1c[6.20%(5.70%,7.50%)vs 5.80%(5.50%,6.50%)],NLRP3[343.29(217.20,504.90)pg/ml vs 245.02(170.00,328.60)pg/ml]and LECT-2[23.24(14.92,27.24)ng/ml vs 17.85(10.30,26.41)ng/ml]expression levels were elevated and the differences were all statistically significant(t=1.103,Z=-2.172,-2.213,-3.239,-2.592,all P<0.05).Multi-factor logistic regression analysis showed that blood FIB[OR(95%CI):4.213(1.481~11.981)]and NLRP3[OR(95%CI):1.004(1.000~1.007)]were independent risk factors for the development of CMVD after PCI for coronary artery disease(Waldχ^(2)=7.274,4.061,all P<0.05).The area under the ROC curve for the predictive value of blood FIB and NLRP3 for the development of CMVD after PCI for coron

关 键 词：冠状动脉微血管疾病 纤维蛋白原 核苷酸结合寡聚化结构域样受体蛋白3 白细胞衍生趋化因子2 

分 类 号：R541.4[医药卫生—心血管疾病] R392.11[医药卫生—内科学]