抗氧化应激生物标志物诊断老年冠状动脉支架术后再狭窄和再闭塞患者的价值

Clinical value of anti-oxidative stress biomarkers for diagnosing in-stent restenosis and in-stent reocclusion after coronary stent implantation in advanced-aged patients

目的研究抗氧化应激标记物诊断老年患者冠状动脉(冠脉)支架术后再狭窄和再闭塞的临床价值。方法回顾性研究,连续选择2010年2月至2017年11月高龄冠脉支架术后再狭窄和再闭塞患者72例。测定冠脉无再狭窄组和多支再狭窄多支再闭塞组患者超氧化物歧化酶3(SOD3)、一氧化氮(NO)、内皮一氧化氮合成酶(eNOS)和丙二醛(MDA)的水平变化。结果老年冠脉支架术后再狭窄组患者SOD3、NO、eNOS水平降低和MDA水平升高。冠脉无再狭窄组比较多支再狭窄多支再闭塞组患者SOD3(20.0±3.2)×10^3U/L比(10.9±3.9)×10^3U/L、NO(61.2±14.2)μmol/L比(28.3±17.2)μmol/L、eNOS(75.9±24.7)ng/L比(33.0±19.6)ng/L和MDA(2.2±1.4)nmol/L比(11.7±3.1)nmol/L,差异有统计学意义(均P<0.01);冠脉再狭窄50%~69%组比较冠脉再狭窄100%组SOD3(21.3±2.9)×10^3U/L比(10.3±4.0)×10^3U/L、NO(59.7±16.7)μmol/L比(38.3±16.3)μmol/L、eNOS(74.5±21.1)ng/L比(41.9±26.8)ng/L和MDA(2.6±3.9)nmol/L比(10.1±3.1)nmol/L,差异有统计学意义(均P<0.01);左心室射血分数(LVEF)≥55%组比较LVEF<30%组SOD3(21.0±4.1)×10^3U/L比(5.3±1.9)×10^3U/L、NO(60.1±14.2)μmol/L比(29.0±13.2)μmol/L、eNOS(74.7±25.1)ng/L比(39.3±20.3)ng/L和MDA(2.3±1.5)nmol/L比(10.0±3.9)nmol/L,差异有统计学意义(均P<0.01);NYHAⅠ级组比较NYHAⅣ级组SOD3(22.1±3.5×10^3U/L比(9.7±2.9)×10^3U/L、NO(62.9±13.9)μmol/L比(24.9±13.3)μmol/L、eNOS(76.7±26.7)ng/L比(41.9±21.5)ng/L和MDA(2.7±1.9)nmol/L比(8.7±3.8)nmol/L,差异有统计学意义(均P<0.01)。结论老年冠脉支架术后抗氧化应激标记物SOD3、NO和eNOS水平变化,可能对高龄冠脉支架术后再狭窄和再闭塞具有诊断价值。

ObjectiveTo study the clinical value of anti-oxidative stress biomarkers for diagnosing in-stent restenosis and in-reocclusion after coronary stent implantation in aged patients. MethodsA total of 72 advanced-aged patients with in-stent restenosis and in-stent reocclusion after coronary stent implantation were successively recruited in this retrospective study from February 2010 to November 2017.Changes in serum superoxide dismutase 3(SOD3), nitric oxide(NO), endothelial cell nitric oxide synthase(eNOS)and malondialdehyde(MDA)levels were measured. ResultsSerum 1evels of SOD3, NO and eNOS decreased and serum MDA levels were elevated in advanced-aged patients with in-stent restenosis.There were significant differences in serum levels of SOD3, NO, eNOS and MDA between the advanced-aged patients without in-stent restenosis and the advanced-aged patients with multivessel in-stent restenosis or reocclusion[(20.0±3.2)×10^3U/L vs.(10.9±3.9)×10^3U/L, (61.2±14.2)μmol/L vs.(28.3±17.2)μmol/L, (75.9±24.7)ng/L vs.(33.0±19.6)ng/L, (2.2±1.4)nmol/L vs.(11.7±3.1)nmol/L, respectively, P<0.01]. Patients with 50-69% restenosis had higher serum levels of SOD3, NO and eNOS and lower levels of MDA than patients with 100% restenosis[(21.3±2.9)×10^3U/L vs.(10.3±4.0)×10^3U/L, (59.7±16.7)μmol/L vs.(38.3±16.3)μmol/L, (74.5±21.1)ng/L vs.(41.9±26.8)ng/L, (2.6±3.9 nmol/L)vs.(10.1±3.1)nmol/L, respectively, P<0.01]. Patients with left ventricular ejection fraction(LVEF)≥55% had higher serum levels of SOD3, NO and eNOS and lower levels of MDA than patients with LVEF<30%[(21.0±4.1)×10^3U/L vs.(5.3±1.9)×10^3U/L, (60.1±14.2)μmol/L vs.(29.0±13.2)μmol/L, (74.7±25.1)ng/L vs.(39.3±20.3)ng/L, (2.3±1.5)nmol/L vs.(10.0±3.9)nmol/L, respectively, P<0.01]. Serum levels of SOD3, NO and eNOS were higher and MDA levels were lower in patients with New York Heart Association(NYHA)Class I than in patients with NYHA Class IV[(22.1±3.5)×10^3U/L vs.(9.7±2.9)×10^3U/L, (62.9±13.9)μmol/L vs.(24.9±13.3)μmol/L, (76.7±26.7)ng/L vs.(41.9±21.5)ng/L, (2.7±1.9)nmol/L vs.(8.7±3.8)nmol/L, respectively, P<0.01]. ConclusionsSerum level changes of anti-oxidative stress biomarkers such as SOD3, NO and eNOS may have clinical value in diagnosing in-stent restenosis and in-reocclusion after coronary stent implantation in aged patients.