血清STC-2和PAPPA及IGF-1水平与老年冠心病PCI术后再狭窄的相关性

Correlation between serum STC-2,PAPPA,IGF-1 levels and restenosis in elderly patients with coronary heart disease after PCI

目的探讨血清斯钙素-2(STC-2)、妊娠相关血浆蛋白A(PAPPA)、胰岛素样生长因子-1(IGF-1)水平与老年冠心病(CHD)经皮冠状动脉介入(PCI)术后再狭窄的相关性。方法选取2017年11月-2019年11月于河南省胸科医院行PCI术后发生再狭窄的92例CHD患者进行研究(再狭窄组),另选取同期行PCI术后未发生再狭窄的92例CHD患者进行对照研究(未狭窄组)。比较再狭窄组、未狭窄组临床资料及血清STC-2、PAPPA、IGF-1水平,分析影响老年CHD患者PCI术后发生再狭窄的因素,评估血清STC-2、PAPPA、IGF-1水平对老年CHD患者PCI术后再狭窄的预测价值。结果再狭窄组患者血清STC-2、PAPPA水平及糖尿病比例、植入支架数量均高于未狭窄组,血清IGF-1水平及支架直径低于未狭窄组,差异均有统计学意义(P均<0.05)。糖尿病、植入支架数量、STC-2、PAPPA是老年CHD患者PCI术后发生再狭窄的危险因素(P<0.05),支架直径、IGF-1是老年CHD患者PCI术后发生再狭窄的保护因素(P<0.05)。血清STC-2、PAPPA、IGF-1预测老年CHD患者PCI术后再狭窄的曲线下面积(AUC)分别为0.877、0.879、0.677,截断值分别为15.93μg/L、9.46μg/L、2.30μg/mL,敏感度分别为79.30%、79.30%、78.30%,特异度分别为88.00%、89.10%、51.10%。血清STC-2、PAPPA联合预测老年CHD患者PCI术后再狭窄的AUC为0.947,敏感度、特异度分别为91.30%、87.00%。结论PCI术后再狭窄的老年CHD患者血清STC-2、PAPPA水平较高,IGF-1水平较低,STC-2、PAPPA联合可提高对PCI术后再狭窄的预测效能,更有助于临床预测老年CHD患者PCI术后再狭窄。

Objective To investigate the correlation between serum stanniocalcin-2(STC-2),pregnancy-associated plasma protein A(PAPPA),insulin like growth factor-1(IGF-1)levels and restenosis after percutaneous coronary intervention(PCI)in elderly patients with coronary heart disease(CHD).Methods A total of 92 CHD patients with restenosis after PCI in our hospital from November 2017 to November 2019 were selected for the study(restenosis group),and 92 CHD patients without restenosis after PCI in the same period were selected for the control study(non stenosis group).The clinical data and serum levels of STC-2,PAPPA and IGF-1 were compared between the restenosis group and the non-stenosis group;the influencing factors of restenosis in elderly CHD patients after PCI were analyzed;the predictive value of serum STC-2,PAPPA and IGF-1 levels for restenosis after PCI in elderly patients with CHD was evaluated.Results The levels of serum STC-2 and PAPPA,the proportion of diabetes mellitus and the number of implanted stents in the restenosis group were higher than those in the non-stenosis group,and the differences were statistically significant(P<0.05);the level of serum IGF-1 and the diameter of stents in the restenosis group were significantly lower than those in the non stenosis group,and the differences were statistically significant(P<0.05);diabetes mellitus,number of implanted stents,STC-2 and PAPPA were risk factors for restenosis in elderly CHD patients after PCI(P<0.05);stent diameter and IGF-1 were protective factors for restenosis in elderly CHD patients after PCI(P<0.05);the areas under the curve(AUC)of serum STC-2,PAPPA and IGF-1 in predicting restenosis in elderly CHD patients after PCI were 0.877,0.879 and 0.677,respectively,the cutoff values were 15.93μg/L,9.46μg/L and 2.30μg/mL,respectively;the sensitivities were 79.3%,79.3%and 78.3%,respectively,and the specificities were 88.00%,89.10%and 51.10%,respectively;the AUC of serum STC-2 combined with PAPPA in predicting restenosis in elderly CHD patients after PCI was 0.947;the sensitivity and specificity were 91.30%and 87.00%,respectively.Conclusions Serum STC-2 and PAPPA levels were higher and IGF-1 level was lower in elderly CHD patients with restenosis after PCI.The combination of STC-2 and PAPPA could improve the prediction of restenosis after PCI,which might be helpful for clinical prediction of restenosis after PCI in elderly CHD patients.