三种血清因子检测对老年急性心肌梗死患者PCI术后再狭窄的预测价值  

Predictive value of three serum factor tests for restenosis after PCI in elderly patients with acute myocardial infarction

作　　者：胡丽君[1] 雷宇[1] 肖涛 HU Li-jun;LEI Yu;XIAO Tao(Department of Cardiovascular Medicine,Deyang People's Hospital,Deyang 618000,Sichuan,China)

机构地区：[1]德阳市人民医院心血管内科,四川德阳618000

出　　处：《心脏杂志》2024年第6期645-649,共5页Chinese Heart Journal

基　　金：四川省德阳市科技计划项目(2023SZZ019)。

摘　　要：目的探究老年急性心肌梗死(AMI)患者血清C-X3-C趋化因子配体1(CX3CL1)、凝集蛋白1(ITLN-1)和可溶性微纤维相关蛋白4(sMFAP4)水平变化及其对经皮冠状动脉介入术(PCI)术后再狭窄的预测价值。方法收集本院2020年10月~2022年10月本院收治的189例均进行PCI治疗的老年AMI患者作为观察对象,对患者进行术后12个月随访,根据是否发生再狭窄分为非再狭窄组(n=129)和再狭窄组(n=60),采用酶联免疫吸附(ELISA)法检测血清CX3CL1、ITLN-1和sMFAP4水平,采用多因素Logistic回归分析老年AMI患者PCI术后再狭窄的影响因素,ROC曲线分析血清CX3CL1、ITLN-1和sMFAP4对老年AMI患者PCI术后再狭窄的预测价值。结果与非再狭窄组相比,再狭窄组高血压患者比例高(P<0.05),TG水平低(P<0.05),CX3CL1水平高(P<0.01),ITLN-1水平低(P<0.05),sMFAP4水平高(P<0.01)。两组在年龄、性别、BMI、糖尿病、饮酒、支架数量、支架直径、梗死部位、病变部位、HDL-C、TC和血肌酐等项目上差异无统计学意义。高血压(P<0.05)、CX3CL1(P<0.01),sMFAP4(P<0.05)是老年AMI患者PCI术后发生再狭窄的独立危险因素,ITLN-1是保护因素(P<0.01)。血清CX3CL1,ITLN-1,sMFAP4单独或三者联合预测PCI术后发生再狭窄的AUC分别为0.810(95%CI:0.746~0.863)、0.828(95%CI:0.766~0.879)、0.782(95%CI:0.716~0.838)、0.923(95%CI:0.875~0.957),灵敏度分别为66.67%、85.00%、85.00%、86.67%,特异度分别为89.15%、72.09%、62.02%、88.37%,三者联合的预测效能优于单独预测(Z=3.680、3.601、4.410;均P<0.01)。结论老年AMI患者血清CX3CL1、sMFAP4水平升高,ITLN-1水平降低,三者对PCI术后发生再狭窄具有一定的预测价值,可作为预测老年AMI患者PCI术后再狭窄的血清标志物。AIM To investigate the changes in serum levels of C-X3-C chemokine ligand 1(CX3CL1),intelectin 1(ITLN-1),and soluble microfibrillar associated protein 4(sMFAP4)in elderly patients with acute myocardial infarction(AMI)and their predictive value for restenosis after percutaneous coronary intervention(PCI).METHODS From October 2020 to October 2022,189 elderly AMI patients who underwent PCI treatment in our hospital were regarded as observation subjects.Patients were followed up for 12 months after surgery and separated into a non restenosis group of 129 cases and a restenosis group of 60 cases based on whether restenosis occurred,enzyme linked immunosorbent assay(ELISA)was applied to detect serum levels of CX3CL1,ITLN-1,and sMFAP4,multivariate Logistic regression was applied to analyze the influencing factors of restenosis after PCI in elderly AMI patients,ROC curve was applied to analyze the predictive value of serum CX3CL1,ITLN-1,and sMFAP4 for restenosis after PCI in elderly AMI patients.RESULTS Compared with the non restenosis group,the restenosis group had a higher proportion of hypertensive patients(P<0.05),lower levels of TG(P<0.05),higher levels of CX3CL1(P<0.01),lower levels of ITLN-1(P<0.05),and higher levels of sMFAP4(P<0.01).There was no significant difference between the two groups in terms of age,gender,BMI,diabetes,alcohol consumption,number of stents,stent diameter,infarct site,lesion site,HDL-C,TC and serum creatinine.Hypertension(P<0.05),CX3CL1(P<0.01),and sMFAP4(P<0.05)are independent risk factors for restenosis in elderly AMI patients after PCI,while ITLN-1 is a protective factor(P<0.01).The AUC of serum CX3CL1,ITLN-1,and sMFAP4 alone or in combination for predicting restenosis after PCI were 0.810(95%CI:0.746~0.863),0.828(95%CI:0.766~0.879),0.782(95%CI:0.716~0.838),0.923(95%CI:0.875~0.957),with sensitivities of 66.67%,85.00%,85.00%,and 86.67%,and specificity of 89.15%,72.09%,62.02%,and 88.37%,respectively,The predictive performance of the combination of the three is better than that of individua

关 键 词：急性心肌梗死 经皮冠状动脉介入术 C-X3-C趋化因子配体1 凝集蛋白1 可溶性微纤维相关蛋白4 

分 类 号：R541.4[医药卫生—心血管疾病]