PCI术后血清细胞因子改变对冠心病患者预后的预测价值

摘要

目的：分析冠心病（ CAD）介入治疗（ PCI）术后血清细胞因子与术后心脏不良事件（ MACE）及预后的相关性。方法：观察78例CAD患者PCI手术治疗效果，比较PCI手术前及术后24 h患者血清C-反应蛋白（ CRP）、肿瘤坏死因子-α（ TNF-α）、白介素（ IL）-6、转化生长因子-β（ TGF-β）及 IL-10水平，采用pearson分析与术前比较有差异的细胞因子间的相关性，用受试者工作曲线（ ROC）分析术后具有相关性细胞因子对PCI预后的诊断价值；以PCI预后的诊断价值高的细胞因子水平中位数进行分组，比较该细胞因子与 PCI术后12周累积MACE发生率的关系。结果：78例CAD患者均成功进行PCI手术，术后12周内有18例并发MACE，未出现术后死亡病例；与术前比较，术后CAD患者CRP及TNF-α水平较治疗前显著升高（ P<0.05）；术后CAD患者血清TNF-α与CRP呈现显著正相关（ r=0.813，P<0.001）；ROC曲线分析显示，CRP以18.73 mg/L为截点值，CRP预测PCI术后并发MACE的敏感性、特异性及曲线下面积均优于20.35 ng/L的TNF-α；高水平CRP患者术后12周累积MACE发生率显著高于低水平患者（ P=0.038）。结论：CAD患者PCI术后血清CRP水平检测对患者预后的诊断均有一定价值。%Objective:To analyze the correlation between serum cytokines and postoperative adverse cardiac events( MACE)and prognosis in patients with coronary heart disease( CAD)after PCI inter-ventional therapy. Methods:The curative effect was observed in 78 cases of CAD patients with PCI interventional treatment. The serum level of CRP,TNF-α,IL-6,TGF-βand IL-10 were compared be-tween before PCI surgery and 24 h after PCI surgery. Pearson analysis was used to compare the correla-tion between different cytokines and MACE,and the receiver operating curve( ROC)was used to ana-lyze the prognostic value of PCI. The median level of cytokine levels with high diagnostic value in the PCI prognosis was grouped,and the relationship between the cytokine and the cumulative incidence of MACE 12 weeks after PCI was compared. Results:PCI surgery was successfully performed in 78 cases of CAD patients,of whom 18 cases were complicated with MACE within 12 weeks,and there were no postoperative deaths. Compared with preoperative,the level of CRP and TNF-α in patients with CAD was significantly increased after PCI surgery( P<0 . 05 ). The serum level of TNF-α was significantly positively correlated with and CRP level in postoperative patients with CAD( r=0 . 813 ,P<0 . 001 ). ROC curve analysis showed that under the condition of CRP 18. 73 mg/L as the cut-off point,the sen-sitivity,specificity and area under the curve of CRP′s prediction of MACE after PCI were better than their counterparts of TNF-α with 20. 35 ng/L. The cumulative incidence of MACE was significantly higher in patients with high level of CRP 12 weeks after surgery than those patients with low levels of ( P=0 . 038 ). Conclusion:Detection of serum CRP level after PCI in patients with CAD has a certain value in diagnosis and prognosis.