冠心病患者内皮素-1水平与PCI术后支架内再狭窄的相关性

Correlation between endothelin-1 and in-stent restenosis after percutaneous coronary intervention in patients with coronary heart disease

目的分析冠状动脉粥样硬化性心脏病(冠心病)患者内皮素-1(ET-1)水平与经皮冠状动脉介入治疗(PCI)术后支架内再狭窄的关系。方法选取2013年1月~2015年12月于辽河油田总医院行PCI的冠心病患者174例,其中男性125例,女性49例,年龄42~71岁。根据随访结果分为狭窄组(36例)和对照组(138例)。收集入选患者的性别、年龄、血脂、合并症、心肌梗死病史、支架数目和直径等方面资料。术后检测ET-1水平,且术后均随访1年,记录有无支架内再狭窄。结果狭窄组合并高血压比例、合并糖尿病比例、置入支架长度、谷草转氨酶和ET-1均高于对照组,置入支架直径低于对照组,差异有统计学意义(P均<0.05)。多因素Logistic回归分析结果显示,合并糖尿病(OR=2.451,95%CI:1.123~5.364)、置入支架直径(OR=0.625,95%CI:0.415~0.994)和ET-1(OR=1.528,95%CI:1.208~2.824)是PCI术后支架内再狭窄的独立影响因素。当ET-1为96.5 pg/ml时,诊断PCI术后1年内支架内再狭窄的敏感性为80.6%,特异性为76.8%。结论冠心病患者PCI术后高水平ET-1与支架内再狭窄有关,检测ET-1水平有助于评估支架内再狭窄的发生风险。

Objective To analyze the relationship between level of endothelin-1 （ET-1） and in-stent restenosis after percutaneous coronary intervention （PCI） in patients with coronary heart disease （CHD）. Methods CHD patients （n=174, male 125, female 49 and aged from 42 to 71） were chosen from the General Hospital of Liaohe Oilfield from Jan. 2013 to Dec. 2015. All of them were divided, according to follow-up results, into stenosis group （n=36） and control group （n=138）. The data was collected including sex, age, blood fat, complications, history of myocardial infarction, and stent numbers and diameter from all patients. The level of ET-1 was detected after PCI, and the patients were followed up for 1 y to record onset status of in-stent restenosis. Results The percentages of patients complicated by hypertension or diabetes, length of stent, and levels of aspertate aminotransferase （AST） and ET-1 were all higher, and stent diameter was lower in stenosis group than those in control group （all P〈0.05）. The results of multi-factor Logistic regression analysis showed that complicated diabetes （OR=2.451, 95%CI 1.123~5.364）, stent diameter （OR=0.625, 95%CI： 0.415~0.994） and ET-1 （OR=1.528, 95%CI： 1.208~2.824） were independent influence factors of in-stent restenosis after PCI in CHD patients. When ET-1 level was 96.5 pg/mL, its sensitivity was 80.6% and specificity was 76.8% in diagnosis of in-stent restenosis after PCI within 1 y in CHD patients. Conclusion The higher level of ET-1 is correlated to in-stent restenosis in CHD patients after PCI, anddetection of ET-1 level is help to review the risk of in-stent restenosis.