PCI治疗后β2微球蛋白变化与冠心病患者支架内再狭窄的关系

Relationship between changes of beta 2-MG and in-stent restenosis in patients with coronary heart disease after PCI

目的探讨冠心病患者PCI治疗前后β2微球蛋白(β2-MG)变化与支架内再狭窄的关系。方法选取行PCI介入治疗的冠心病患者162例,分别于术前12 h和术后1月检测血清β2-MG的含量,PCI术后1年行冠状动脉造影检查,评估患者是否存在冠状动脉再狭窄,并根据冠状动脉造影结果分组,支架血管直径狭窄≥50%为支架内再狭窄(ISR)组,支架血管直径狭窄<50%为对照组。用Gensini积分和冠状动脉病变支数评价冠状动脉狭窄程度,采用Spearman相关性分析评估β2-MG与Gensini积分及冠状动脉病变支数的相关性。结果PCI术前两组患者冠状动脉病变数量、病变部位、病变程度差异无显著性,同时两组术前12 h与术后1月白细胞、血红蛋白、血小板、尿酸、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白波动差异无统计学意义(P>0.05);ISR组与对照组术前血清β2-MG差异无统计学意义(P>0.05),行PCI术后1月两组患者血清β2-MG均减小,ISR组高于对照组,差异有统计学意义(P<0.05);多元Logistic回归分析结果显示,糖尿病病史(OR=2.435)、术前12 h与术后1月β2-MG的差值(OR=1.861)是PCI术后ISR发生的危险因素。Spearman相关性分析显示术前12 h与术后1月β2-MG的差值与Gensini积分呈正相关(r=1.231,P=0.025),β2-MG与冠状动脉病变支数呈正相关(r=1626,P=0.014)。以ISR为结果变量,对术前12 h与术后1月β2-MG差值进行ROC分析,显示cut-off值为2.530 mg/L,ROC曲线下面积为0.758,标准误0.050,Z值2.391,敏感度84.10%,特异度72.90%。结论PCI术后ISR组血清β2-MG水平明显高于未狭窄组,血清β2-MG水平与PCI术后再狭窄呈正相关,提示β2-MG可能为PCI术后ISR的预测因素。

Aim To investigate the relationship between changes of beta 2-microglobulin(β2-MG)and in-stent restenosis in patients with coronary heart disease after PCI.Methods 162 patients with coronary heart disease treated by PCI were selected.Serumβ2-MG levels were measured 12 hours before operation and 1 year after operation respectively.Coronary angiography was performed 1 year after PCI.The patients were divided into ISR group and control group according to the results of coronary angiography.Spearman correlation analysis was used to evaluate the correlation betweenβ2-MG and Gensini integral and the number of coronary lesion branches.Gensini integral and the number of coronary lesion branches were used to evaluate the degree of coronary stenosis and to analyze the relationship betweenβ2-MG and ISR.Results There was no significant difference in the number of coronary lesions,lesion location and lesion degree.Additionally,there was no significant difference in blood chemical change between the two groups 12 hours before operation and 1 month after operation(P>0.05).There was no significant difference in serumβ2-MG between the ISI group and the control group before PCI(P>0.05).One month after PCI,the serumβ2-MG of the two groups decreased,while it was higher in the ISI group than that of control group(P<0.05).There was no significant difference in the number,location and degree of coronary artery lesions between the two groups before PCI(P<0.05).Multivariate Logistic regression analysis showed that the incidence of ISR after PCI was correlated with the history of diabetes mellitus,difference ofβ2-MG between 12 hours before PCI and 1 month after PCI(P<0.05).Spearman correlation analysis showed thatβ2-MG was positively correlated with Gensini score(r=1.231,P=0.025),and the difference ofβ2-MG between 12 hours before PCI and 1 month after PCI was positively correlated with the number of coronary lesion branches(r=1626,P=0.014).The difference ofβ2-MG between 12 hours before PCI and 1 month after PCI was analyzed by ROC with ISR as the result variable.The cut-off value was 2.530 mg/L,the area under the ROC curve was 0.758,the standard error was 0.050,the Z value was 2.391,the sensitivity was 84.10%,and the specificity was 72.90%.Conclusions The serumβ2-MG level in ISR group was significantly higher than that in non-stenosis group after PCI.The serumβ2-MG level was positively correlated with restenosis after PCI,suggesting thatβ2-MG may be one of the risk factors for ISR after PCI.