老年经皮冠状动脉介入治疗术后支架内再狭窄患者胱抑素C、基质金属蛋白酶抑制剂-1、分泌型卷曲相关蛋白5表达及临床意义

Expression and clinical significance of cystatin C,tissue inhibitor of metalloproteinase-1 and secreted frizzled-related protein5 in elderly patients with in-stent restenosis after percutaneous coronary intervention

目的探讨老年经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)患者胱抑素C(CysC)、基质金属蛋白酶抑制剂-1(TIMP-1)、分泌型卷曲相关蛋白5(SFRP-5)表达及对靶血管病变的预测价值。方法选取2020年5月至2022年5月保定市第一中心医院PCI术后1年内发生ISR的65例老年冠心病患者作为观察组,选取同期65例PCI术后1年内未发生ISR的老年冠心病患者作为对照组,比较两组一般资料、术后血清CysC、TIMP-1、SFRP-5水平,分析血清CysC、TIMP-1、SFRP-5水平与ISR发生的相关性,并比较观察组不同Mehran分型患者血清CysC、TIMP-1、SFRP-5水平,分析各指标水平与Mehran分型的相关性,分析血清CysC、TIMP-1、SFRP-5水平预测靶血管发生ISR的价值。结果观察组血清CysC水平高于对照组(t=6.949,P<0.05),TIMP-1、SFRP-5水平低于对照组(t=7.301、8.765,P<0.05);血清CysC水平与ISR的发生呈正相关(r=0.587,P<0.05),TIMP-1、SFRP-5水平与ISR的发生呈负相关(r=-0.609、-0.640,P<0.05)。观察组四种Mehran分型的患者CysC、TIMP-1、SFRP-5水平差异有统计学意义(F=10.759、8.326、19.764,P<0.05)。随着Mehran分型Ⅰ型到Ⅳ型的变化,CysC水平逐渐升高,TIMP-1、SFRP-5水平逐渐下降,差异有统计学意义(P<0.05)。血清CysC水平与ISR患者Mehran分型呈正相关关系(r=0.722,P<0.05),TIMP-1、SFRP-5水平与Mehran分型呈负相关关系(r=-0.799、-0.826,P<0.05)。血清CysC、TIMP-1、SFRP-5水平预测老年冠心病患者PCI术后1年内靶血管发生ISR的曲线下面积(AUC)分别为0.807(95%CI=0.729~0.871)、0.786(95%CI=0.706~0.853)、0.811(95%CI=0.733~0.874),联合预测的AUC最大,为0.943(95%CI=0.887~0.976)。结论老年冠心病PCI术后患者血清CysC水平升高,TIMP-1、SFRP-5水平降低与ISR的发生发展相关,术后早期检测各指标水平有助于预测靶血管发生ISR风险。

Objective To investigate the expression of cystatin C(CysC),tissue inhibitor of metalloproteinase-1(TIMP-1)and secreted frizzled-related protein5(SFRP-5)in elderly patients with in-stent restenosis(ISR)after percutaneous coronary intervention(PCI)and its predictive value for target vessel lesions.Methods A total of 65 elderly patients with coronary heart disease(CHD)who developed ISR within 1 year after PCI in Baoding First Central Hospital from May 2020 to May 2022 were selected as the observation group,and 65 elderly CHD patients in the same period without ISR within 1 year after PCI were selected as the control group.The general information,postoperative serum CysC,TIMP-1 and SFRP-5 levels of the two groups were compared,and the correlation between serum CysC,TIMP-1 and SFRP-5 levels and the occurrence of ISR was analyzed.The serum CysC,TIMP-1 and SFRP-5 levels of patients with different Mehran subtypes in the observation group were compared,and the correlation between each index level and Mehran subtype was analyzed.The value of serum CysC,TIMP-1 and SFRP-5 levels in predicting the occurrence of ISR in the target vessel was evaluated.Results Serum CysC level in the observation group was higher than that in the control group(t=6.949,P<0.05),while TIMP-1 and SFRP-5 levels were lower than those in the control group(t=7.301,8.765;P<0.05).Serum CysC level was positively correlated with the occurrence of ISR(r=0.587,P<0.05),while TIMP-1 and SFRP-5 levels were negatively correlated with the occurrence of ISR(r=-0.609,-0.640;P<0.05).Differences in the serum levels of CysC,TIMP-1 and SFRP-5 among the four Mehran subtypes in the observation group were statistically significant(F=10.759,8.326,19.764;P<0.05).As the Mehran suptype changed from typeⅠto typeⅣ,the level of CysC gradually increased,while the levels of TIMP-1 and SFRP-5 gradually decreased,with significant differences(P<0.05).Serum CysC level was positively correlated with the Mehran subtype of ISR patients(r=0.722,P<0.05),while TIMP-1 and SFRP-5 levels were negatively correlated with Mehran subtype(r=-0.799,-0.826;P<0.05).The area under the curve(AUC)values for predicting the occurence of ISR in elderly patients with CHD after PCI within 1 year using serum levels of CysC,TIMP-1 and SFRP-5 were 0.807(95%CI=0.729-0.871),0.786(95%CI=0.706-0.853),and 0.811(95%CI=0.733-0.874),respectively.The combined prediction had the largest AUC value of 0.943(95%CI=0.887-0.976).Conclusion Elevated serum CysC level and decreased TIMP-1 and SFRP-5 levels in elderly CHD patients after PCI were found to be associated with the development of ISR.Serum levels of these indicators in the early postoperative period can be used to predict the risk of ISR in the target vessel.