血清超敏C-反应蛋白动态变化与颈内动脉支架置入术后再狭窄的相关性

Correlation between the dynamic changes of senlm high-sensitivity Creactive protein and restenosis after internal carotid a^ery stenting

目的探讨颈动脉支架置人术（carotidarterystenting^CAS）后血清超敏C一反应蛋白（high—sensitiveC—reactiveprotein，hs—CRP）的动态变化及其与支架内再狭窄的相关性。方法在南京军区南京总医院神经内科行CAS治疗的患者，分别在术前、术后12h、7d、3个月和6个月时检测血清hs—CRP水平，并在6个月后复查脑血管造影，观察有无支架内再狭窄。结果纳入84例行CAS治疗的患者，15例（24％）患者在CAS术后出现支架再狭窄，其中3例狭窄程度〉50％，12例狭窄程度为30％～50％。所有患者术后12hue血清hs—CRP水平均显著高于治疗前（P均〈0．01），而术后6个月时较治疗前显著降低（P均〈0．01）。单变量分析显示，再狭窄组糖尿病比例显著高于无再狭窄组（P〈0．01）。再狭窄组术后7d[（8．83±1．94）mg／L对（6．77±1．63）mg／L，t=14．398，P=0．044]、术后3个月[（8．26±1．32）rng／L对（4．58±1．45）rng／L，t=17．569，P=0．008]和术后6个月[（7．04±1．07）rng／L对（3．12±1．28）rng／L，t=21．867，P=0．003]血清hs—CRP水平显著高于无再狭窄组，而术前与术后6个月时血清hs—CRP水平的差值（△hs—CRP）显著低于无再狭窄组[（0．85-I-0．13）mg／L对（4．89±0．94）耻扎，t=16．987，P=0．000]。多变量logistic回归分析显示，Ahs—CRP（优势比2．392，95％可信区间1．538～3．513，P=0．009）和糖尿病（优势比1．840，95％可信区间l_372～2．241，P=0．023）是支架再狭窄的独立危险因素。结论CAS术后12h时血清hs—CRP水平显著升高，随后持续下降。术后6个月时血清hs—CRP下降程度越明显，发生支架内再狭窄的风险越低。

Objective To investigate the dynamic change of serum high sensitive C-reactive protein （hs- CRP） after carotid artery stenting （CAS） and its correlation with in-stent restenosis. Methods The serum hs- CRP levels were determined before procedure, at 12 hours, 7 days, 3 and 6 months after procedure in patients who underwent CAS in the Department of Neurology, Jinling Hospital, Nanjing. Their cerebral angiography was reexamined and whether there was in-stent restenosis after 6 months was observed. Results Eighty-four patients treated with CAS were included in the study. Fifteen （24%） had in-stent restenosis after CAS. The stenosis in 3 of them was 〉 50%, and the stenosis in 12 of them was 30% to 50%. The serum hs-CRP levels in all patients after procedure were significantly higher than those before treatment （all P 〈 0. 01 ）, and they were significantly lower at 6 months after procedure than before treatment （all P 〈0. 01）. Univariate analysis showed that the proportion of diabetes in the restenosis group was significantly higher than that in the non-restenosis group （P 〈0. 01）. At 7 days （8. 83 ± 1.94 mg/L vs. 6. 77±1.63 mg/L, t = 14. 398, P =0. 044）, 3 months after procedure （8. 26 ±1.32 mg/L vs. 4. 58 ＋ 1.45 mg/L, t = 17. 569, P = 0. 008） and 6 months after procedure （7. 04±1.07 mg/L vs. 3. 12±1.28 mg/L, t =21. 867, P =0. 003）, the serum hs-CRP levels in the restenosisgroup were significantly higher than those in the non-restenosis group, and the difference of the serum hs-CRP level （A hs-CRP） before procedure and at 6 month after procedure was significantly lower than that in the non- restenosis ffoup （0. 85 ±0. 13 mg/L vs. 4. 89±0. 94 mg/L, t = 16. 987, P = 0. 000）. Multivariate logistic regression analysis showed that Ahs-CRP （odds ratio [ OR] 2. 392, 95% confidence interval [ CI] 1. 538 - 3. 513; P =0. 009） and diabetes （OR 1. 840, 95% C! 1. 372 -2. 241; P =0. 023） were the risk factors for in- stent restenosis. Conclmiom The serum hs-CRP level increased significantly at 12 hours after CAS procedure, and then decreased continuously. At 6 months after procedure, the more decrease of the serum hs-CRP level, the lower risk of oceurring in-stent restenosis was.