妊娠相关α血浆蛋白对经皮冠状动脉支架置入术后再狭窄的预测价值

The predictive value of plasma PAPP-α in development of restenosis after coronary stent implantation.

目的探讨冠状动脉支架置入术前后妊娠相关α血浆蛋白(PAPP-α)的变化,以及其对术后6个月内再狭窄发生的预测价值。方法2005年2月至11月中南大学湘雅第二医院比较55例支架置入术患者(不稳定型心绞痛34例,稳定性心绞痛17例,急性心肌梗死4周后4例)手术前及术后24hPAPP-α、高敏C反应蛋白(hs-CRP)、肌钙蛋白I、肌酸激酶同工酶(CK-MB)质量浓度,并于术后6个月复查冠脉造影,采用定量方法分析冠状动脉的狭窄,计算后期内径丧失指数。分析手术前后PAPP-α水平与再狭窄发生的关系。结果支架置入术后24hPAPP-α、hs-CRP较术前升高(P<0.05),而肌钙蛋白I、CK-MB无明显变化。手术后6个月内有再狭窄的患者术后PAPP-α较无再狭窄的患者高(P=0.02),且PAPP-α与支架置入术后冠脉后期内径丢失指数呈正相关(r=0.70,P<0.001);而有再狭窄的患者与无再狭窄的比较术前PAPP-α差异无显著性(P>0.05),且PAPP-α与后期内径丢失指数相关性差(r=0.16,P=0.24)。结论支架置入术可导致体内PAPP-α与hs-CRP合成增加,并在术后6个月内再狭窄的发生重要作用。

Objective To investigate the changes and clinical value of PAPP-α after coronary stent implantation. Methods The study inwdved 56 patients with ischaemic heart disease（34 with UAP,17 with AP,4 with documented MI）who underwent elective coronary stent implantation. Venous blood samples were drawn before and 24 hours after operation, PAPP-α,TnI,CK-MB and hs-CRP concentrations were measured. The patients were scheduled for angiography six months after coronary stent implantation. Late loss index was calculated using quantitative coronary angiography. After follow up, the relationship was analysed between PAPP-α concentrations and restenosis. Results PAPP-α and hs-CRP concentrations in blood increased 24 hours after coronary stent implantation. The change of PAPP-ot concentrations correlated with hs-CRP,but not of Tropin i and CK-MB. PAPP-α concentrations after coronary stent implantation were higher in patients with late restenosis than in those without （ P 〈 0. 001 ） six months after implantation, but concentrations before stent implantation were not（ P =0. 02）. There was a positive correlation between changes in PAPP-α concentrations 24 h after coronary stent implantation and late loss index six months after coronary stent implantation （r = 0. 70, P 〈 0. 001 ）, but not before stent implantation （P 〉 0.05 ）. Conclusion Coronary stent implantation induces PAPP-α production. This may play an important role in late restenosis after coronary stent implantation.