血浆内皮素-1水平与冠状动脉侧支循环形成的相关性研究

Correlation between plasma endothelin-1 and coronary collateral circulation formation

目的探讨血浆内皮素-1(ET-1)水平与冠状动脉慢性完全闭塞(CTO)患者冠状动脉侧支循环(CCC)形成的关系。方法回顾性分析2014年1月~2016年12月于国药东风公司总医院心内科住院的CTO病变患者158例临床资料,其中男性102例,女性56例。按Rentrop分级标准对患者的侧支血管情况进行分级,Rentrop 0~Ⅰ级视为CCC形成不良(n=73),而RentropⅡ~Ⅲ级视为CCC形成良好(n=85)。收集患者的临床资料,包括高敏C反应蛋白(hs-CRR)、白细胞计数(WBC)、左室射血分数(LVEF)等,采用放射免疫法检测血浆ET-1水平。结果 CCC形成不良组的糖尿病比例、WBC、hsCRR和多支病变比例高于CCC形成良好组,差异具有统计学意义(P均<0.05)。而CCC形成良好组的LVEF和右冠状动脉闭塞比例明显高于CCC形成不良组,差异具有统计学意义(P均<0.05)。CCC形成不良组和形成良好组的血浆ET-1水平分别为(81.2±10.1)pg/ml和(67.5±9.4)pg/ml,差异有统计学意义(P<0.01)。Rentrop 0级和Ⅰ级患者的血浆ET-1水平均高于RentropⅡ级和Ⅲ级患者,差异有统计学意义(P均<0.05)。多因素Logistic回归分析结果表明,血浆ET-1水平升高是CCC形成良好的危险因素(OR=2.24,95%CI:1.35~3.72;P<0.01)。其他影响CCC形成的因素包括糖尿病、hs-CRP和右冠状动脉闭塞等。ET-1预测CCC形成不良的ROC曲线下面积为0.80(95%CI:0.72-0.88,P<0.01;最佳截点75.3pg/ml,预测CCC形成不良的敏感性为69.0%,特异性为79.0%。结论在冠状动脉慢性完全闭塞患者中,血浆内皮素-1和冠状动脉侧支循环的形成密切相关,且高水平的ET-1是冠状动脉侧支循环形成良好的独立危险因素。

Objective To discuss the relationship between plasma endothelin-1(ET-1)and formation of coronary collateral circulation(CCC)in patients with chronic total occlusion(CTO)of coronary artery.Methods The clinical materials of CTO patients(n=158,male102and female56)from the Department of Cardiology of the General Hospital of Guoyao Dongfeng Company were retrospectively analyzed from Jan.2014to Dec.2016.The situation of collateral vessels was graded according to Rentrop grading criteria in all patients.Rentrop grades0-I was regarded as poor CCC formation(group1,n=73),and Rentrop gradesⅡ-Ⅲ,as good CCC formation(group2,n=85).The clinical data,including high-sensitivity C-reactive protein(hs-CRP),white blood cell count(WBC)and left ventricular ejection fraction(LVEF)were collected,and level of plasma ET-1was detected by using radioimmunoassay(RIA).Results The percentages of patients with diabetes and multi-vessel lesions,and WBC and hs-CRR were higher in group1than those in group2(all P<0.05).LVEF and percentage of patients with right coronary occlusion were higher in group2than those in group1(all P<0.05).The level of plasma ET-1was(81.2±10.1)pg/mL in group1and(67.5±9.4)pg/mL in group2(P<0.01).The level of plasma ET-1was higher in patients with Rentrop grades0or I than that in patients with Rentrop gradesⅡorⅢ(all P<0.05).The results of multi-factor Logistic regression analysis showed that increased level of plasma ET-1was a risk factor of good CCC formation(OR=2.24,95%CI:1.35~3.72,P<0.01),and other influence factors on CCC formation included diabetes,hs-CRP and right coronary occlusion.In prediction of poor CCC formation by ET-1,the AUC of ROC was0.80(95%CI:0.72~0.88,P<0.01),the optimum cut-off point was75.3pg/mL,sensitivity was69.0%and specificity was79.0%.Conclusion The level of plasma ET-1is closely correlated to CCC formation,and higher ET-1level is an independent risk factor of good CCC formation in CTO patients.