血清内脂素水平与药物洗脱支架内再狭窄的相关性研究

摘要

目的 探讨血清内脏脂肪素(内脂素)水平与药物洗脱支架置入术后支架内再狭窄(ISR)之间的关系.方法 选取于2015年1月~2017年6月于重庆市江津区中心医院心内科行药物洗脱支架置入术的冠状动脉粥样硬化性心脏病(冠心病)患者420例为研究对象,根据术后1年是否发生ISR将其分为ISR组(n=58)和非ISR组(n=362).比较两组患者的临床资料,并采用ELISA法测定术前和术后4 h的血清内脂素水平.结果 ISR组和非ISR组患者术前的血清内脂素水平无明显差异[(13.1±6.4)ng/ml vs.(12.5 ±5.9)ng/ml;P=0.48].ISR组和非ISR组患者术后的血清内脂素水平分别为(45.1±9.6)ng/ml、(34.7 ±7.5)ng/ml,差异有统计学意义(P<0.01).多因素Logistic回归分析结果表明,术后血清内脂素水平(OR=1.83,95%CI:1.21~2.75;P<0.01)、糖尿病(OR=2.36,95%CI:1.16~4.80;P<0.05)、支架长度(OR=1.43,95%CI:1.05~1.96;P<0.05)和支架直径(OR=0.62,95%CI:0.47~0.81;P<0.01)是药物洗脱支架置入术后ISR的独立预测因素.经ROC曲线获得的术后血清内脂素预测ISR的曲线下面积为0.82(95%CI:0.75~0.89).最佳预测截点为36.8 ng/ml,其敏感性为74%,特异性为79%.结论 药物洗脱支架置入术后的血清内脂素水平与ISR密切相关,是ISR的一项独立预测因素.%Objective To investigate the relationship between serum visfatin level and in-stent restenosis (ISR) after drug-eluting stents (DES) implantation. Methods From January 2015 to June 2017, a total of 420 patients with coronary heart disease who underwent DES implantation were included. According to the presence or absence of ISR, these patients were divided into the ISR (n=58) and non-ISR (n=362) groups. The clinical data between the 2 groups were compared, and ELISA method was used to measure the level of serum visfatin before and within 4h after procedure. Results The serum levels of visfatin before procedure were not different between ISR and non-ISR groups [(13.1±6.4) ng/ml vs. (12.5±5.9) ng/ml; P=0.48]. The serum visfatin level after procedure was (45.1 ±9.6) ng/ml and (34.7±7.5) ng/ml in ISR and non-ISR groups, respectively, with significant difference between the 2 groups (P<0.01). Result of multivariate logistic regression analysis indicated that post-procedural serum visfatin level (OR=1.84, 95%CI: 1.12~2.38; P<0.01), diabetes (OR=2.36, 95%CI: 1.16~4.80; P<0.05), stent length (OR=1.43, 95%CI: 1.05~1.96; P<0.05) and stent diameter (OR=0.62, 95%CI: 0.47~0.81; P<0.01) were independent predictors for ISR after drug-eluting stent implantation. Result of ROC curve analysis showed that the area under the curve for post-procedural visfatin to predict ISR was 0.82 (95%CI: 0.75~0.89), and the optimal cut-off value was 36.8 ng/ml, with a sensitivity of 74% and a specificity of 79%. Conclusion The serum visfatin level after placement of drug-eluting stents is closely associated with ISR, and it is an independent predictor for ISR.