血清CML、HB-EGF、DPP-4与冠心病合并2型糖尿病患者冠状动脉病变和PCI术后支架内再狭窄的关系分析  

Relationship between serum CML,HB-EGF,DPP-4 and coronary artery disease and in-stent restenosis after PCI in patients with coronary heart disease combine with type 2 diabetes mellitus

作　　者：杨小龙 赵伟 金龙 马宏恩 许淑娣 YANG Xiaolong;ZHAO Wei;JIN Long;MA Hong′en;XU Shudi(Department of Cardiovascular Diseases,Xi′an Ninth Hospital,Xi'an,Shaanxi 710054,China)

机构地区：[1]西安市第九医院心血管内科,陕西西安710054

出　　处：《国际检验医学杂志》2024年第23期2867-2872,共6页International Journal of Laboratory Medicine

基　　金：国家自然科学基金面上项目(81673787)。

摘　　要：目的 探讨血清Nε-羧甲基赖氨酸(CML)、肝素结合性表皮生长因子(HB-EGF)、二肽基肽酶-4(DPP-4)与冠心病(CHD)合并2型糖尿病(T2DM)患者冠状动脉病变和经皮冠状动脉介入(PCI)术后支架内再狭窄(ISR)的关系。方法 选取2019年1月至2022年12月该院接受PCI术治疗的CHD合并T2DM患者350例为研究对象,术前根据冠状动脉病变累及血管支数,将患者分为单支病变组(198例)、双支病变组(134例)、多支病变组(18例)。检测血清CML、HB-EGF、DPP-4水平。PCI术后1年随访,根据是否发生ISR,将患者分为ISR组(65例)和非ISR组(285例)。采用多因素Logistic回归分析CHD合并T2DM患者PCI术后ISR的危险因素,并构建风险列线图预测模型,采用受试者工作特征(ROC)曲线分析预测模型对CHD合并T2DM患者PCI术后ISR的预测效能。结果 多支病变组血清CML、HB-EGF、DPP-4水平高于双支病变组、单支病变组(P<0.05),且双支病变组血清CML、HB-EGF、DPP-4水平高于单支病变组(P<0.05)。ISR组血清CML、HB-EGF、DPP-4水平高于非ISR组(P<0.05)。高SYNTAX评分、高CML、HB-EGF、DPP-4水平为CHD合并T2DM患者PCI术后ISR的独立危险因素(P<0.05)。ROC曲线分析结果显示,SYNTAX评分、CML、HB-EGF、DPP-4水平及列线图预测模型的曲线下面积分别为0.806、0.644、0.760、0.769、0.931。Bootstrap法(B=1 000)对列线图预测模型进行内部验证显示,校准曲线与理想曲线基本重合,一致性指数为0.863,该模型预测能力较好。决策曲线显示,该模型的阈值概率范围为0.01~0.93,其净收益率>0,高于两条无效线。结论 血清CML、HB-EGF、DPP-4水平与CHD合并T2DM患者冠状动脉病变、PCI术后ISR有关,构建的列线图预测模型对PCI术后ISR有良好的预测价值。Objective To explore the relationship between serum Nε-carboxymethyl lysine(CML),heparin-binding epidermal growth factor(HB-EGF),dipeptidyl peptidase-4(DPP-4) and coronary artery disease and in-stent restenosis(ISR) after percutaneous coronary intervention(PCI) in patients with coronary heart disease(CHD) combine with type 2 diabetes mellitus(T2DM).Methods A total of 350 patients with CHD combine with T2DM who underwent PCI in the hospital from January 2019 to December 2022 were selected as the research objects,according to the number of vessels involved in coronary artery disease before operation,patients were divided into single-vessel disease group(198 cases),double-vessel disease group(134 cases) and multi-vessel disease group(18 cases).The levels of serum CML,HB-EGF and DPP-4 were detected.The patients were followed up for 1 year after PCI,according to whether ISR occurred,patients were divided into ISR group(65 cases) and non-ISR group(285 cases).The risk factors of ISR after PCI in patients with CHD combine with T2DM were analyzed by multivariate Logistic regression,the risk nomogram prediction model was constructed,the predictive efficacy of the prediction model for ISR after PCI in patients with CHD combine with T2DM was analyzed by receiver operating characteristic(ROC) curve.Results The levels of serum CML,HB-EGF and DPP-4 in multi-vessel disease group were significantly higher than those in double-vessel disease group and single-vessel disease group(P<0.05),and those in double-vessel disease group were higher than those in single-vessel disease group(P<0.05).The serum levels of CML,HB-EGF and DPP-4 in ISR group were higher than those in non-ISR group(P<0.05).High SYNTAX score,high CML,HB-EGF and DPP-4 levels were independent risk factors for ISR after PCI in patients with CHD combine with T2DM(P<0.05).The results of ROC curve analysis showed that the area under the curve of SYNTAX score,CML,HB-EGF,DPP-4 levels and nomogram prediction model were 0.806,0.644,0.760,0.769 and 0.931,respectively.The nomog

关 键 词：冠心病 2型糖尿病 经皮冠状动脉介入 冠状动脉病变 支架内再狭窄 Nε-羧甲基赖氨酸 肝素结合性表皮生长因子 二肽基肽酶-4 

分 类 号：R541.4[医药卫生—心血管疾病] R587.2[医药卫生—内科学]