血垂体腺苷酸环化酶激活肽38表达与冠心病患者经皮冠状动脉介入术后需再次血运重建的相关性研究

摘要

目的 分析冠心病患者行经皮冠状动脉介入( PCI)术后血垂体腺苷酸环化酶激活肽(PACAP)-38的表达及与需要再次血运重建的相关性. 方法 抽取焦作市第二人民医院心内科二区于2016年1月至2017年6月PCI术后因胸痛复查的冠心病患者114例作为研究对象,基于复查结果分为再次血运重建组40例和非再次血运重建组74例,比较两组基线资料、心脏标记物、血流动力学指标和血PACAP-38 mRNA表达.多因素logistic分析再次血运重建的风险和保护因素,ROC曲线计算血PACAP-38 mRNA的预测价值. 结果 与非再次血运重建组比较,再次血运重建组患者的高敏肌钙蛋白I(hs-cTnI)、肌酸激酶(CK)、乳酸脱氢酶(LDH)和脂蛋白a[ Lp( a)]表达显著升高,而射血分数(EF)、每搏输出量(SV)、左室缩短分数( FS)和局部射血分数( REF)显著降低(均为P<0. 05).再次血运重建组患者的PACAP-38 mRNA相对表达显著低于非再次血运重建组(439. 85 ± 85. 56比625. 55 ± 75. 21,t=4. 896,P=0. 0006). Killip分级越高,冠心病患者PCI术后血PACAP-38 mRNA表达越低(P<0. 05).完全血运重建患者的血PACAP-38 mRNA表达显著低于不完全血运重建患者(357. 52 ± 72. 31比454. 52 ± 86. 35,t=3. 073,P=0. 0106). Pearson相关性分析显示,再次血运重建患者的PACAP-38 mRNA表达与hs-cTnI、CK、LDH、TG、TC、Lp(a)、纤维蛋白原和N末端B型利钠肽原(NT-proBNP)呈显著负相关性,而与EF、SV和REF呈显著正相关性(均为P<0. 05).多因素logistic回归分析显示,hs-cTnI、CK、LDH、冠状动脉病变血管数、Lp(a)、NT-proBNP、左室舒张末内径、吸烟和高血压均是冠心病患者PCI术后需要再次血运重建的独立预测危险因素,而PACAP-38、REF、EF和SV是独立预测保护因素(均为P<0. 01). ROC曲线显示,PACAP-38 mRNA表达对冠心病患者PCI术后再次血运重建和是否完全血运重建具有预测价值. 结论 冠心病患者PCI术后血PACAP-38 mRNA<443. 50时有再次血运重建风险.%Objective To analyze the correlation of the expression of pituitary adenylate cyclase activating peptide (PACAP) -38 and revascularization in patients with coronary heart disease ( CHD) after percutaneous coronary intervention ( PCI) . Methods A total of 114 cases of patients with CHD were enrolled into this study in Cardiology Department of Jiaozuo Second People’s Hospital from January 2016 to June 2017. Based on the results of the review of their follow-up data, 40 cases were included into revascularization group while 74 cases were included into non-revascularization group. Their baseline data, serum cardiac markers, hemodynamic parameters and PACAP-38 mRNA expression were compared between the two groups. The risk factors and protective factors of revascularization were analyzed by multivariate logistic analysis. The predictive value of PACAP-38 was calculated by receiver operating curve ( ROC) curve. Results Compared with non-revascularization group, level of hypersensitivity troponin I (hs-cTnI), creatinine kinase ( CK ), lactate dehydrogenase ( LDH ) and lipoprotein a [ Lp ( a )] in revascularization group were significantly higher (all P<0. 05), and the values of ejection fraction (EF), stoke volume (SV), fraction shortening (FS) and regional ejection fraction (REF) were significantly lower ( all P<0. 05). Expression of PACAP-38 mRNA in revascularization group was significantly lower than that in non-revascularization group (439. 85 ± 85. 56 vs. 625. 55 ± 75. 21, t=4. 896, P=0. 0006). The higher Killip grade, the lower the expression of PACAP-38 mRNA in patients with CHD after PCI (P<0. 05). The expression of PACAP-38 mRNA in complete revascularization group was significantly lower than that in incomplete revascularization group (357. 52 ± 72. 31 vs. 454. 52 ± 86. 35, t=3. 073, P=0. 0106). Pearson correlation analysis showed that the expression of PACAP-38 mRNA in revascularization group was negatively correlated with hs-cTnI, CK, LDH, TG, TC, Lp(a), FIB, NT-proBNP. Multiple factor logistic regression analysis showed hs-cTnI, CK, LDH, the number of coronary vessels, Lp ( a), NT-proBNP, LVEDD, smoking, hypertension and Killip classification were independent predictors for the prediction of blood transport after PCI operation in patients with CHD ( P <0. 01 ) . PACAP-38, REF, EF and SV were independent predictive protective factors ( P<0. 01) . The ROC curve showed that PACAP-38 expression had the predictive value for revascularization and complete revascularization after PCI in patients with CHD. Conclusions For post-PCI CHD patients, expression of PACAP mRNA lower than 443. 50 have a risk of revascularization and may be a cut-off point for revascularization.