血清超敏C反应蛋白对颈动脉支架植入术后再狭窄的预测价值研究

A Predictive Value of Serum Hypersensitive C-reactive Protein in Restenosis Following Carotid Artery Stenting

目的探讨血清超敏C反应蛋白(hs-CRP)与颈动脉狭窄及其颈动脉支架植入术(CAS)后再狭窄的关系,为临床应用提供参考依据。方法选择2015年1月～2016年12月在本院神经内科行CAS治疗的患者168例,采集其手术前、术后1d、术后7d、术后3个月及术后6个月的空腹静脉血,检测血清hs-CRP水平,分析其与血管狭窄程度及CAS术后支架内再狭窄的关系。结果颈动脉狭窄程度越高,术前患者的血清hs-CRP水平越高,差异有统计学意义(P <0.05)。术后6个月支架内再狭窄发生率为19.05%(32/168)。术前和术后1 d再狭窄组与未再狭窄组患者的血清hs-CRP水平差异均无统计学意义(P>0.05),而术后7d、术后3个月及术后6个月,再狭窄组高于未再狭窄组,未再狭窄组的△hs-CRP高于再狭窄组,差异均有统计学意义(P <0.05);术后1d两组患者的血清hs-CRP水平均升高,术后7d再狭窄组仍高于术前,而未再狭窄组已低于术前,差异均有统计学意义(P <0.05)。多因素回归分析结果显示△hs-CRP是CAS术后支架内再狭窄的独立危险因素。结论血清hs-CRP水平与颈动脉狭窄程度呈正相关,在CAS术后短期内可出现血清hs-CRP快速升高,术后血清hs-CRP水平维持较高水平与支架内再狭窄密切相关,其动态变化对再狭窄具有一定的预测价值。

Objective To investigate the relationship between serum hypersensitive C-reactive protein (hs-CRP) and carotid artery stenosis and restenosis after carotid artery stenting (CAS),so as to provide references for its clinical application. Methods One hundred and sixty-eight patients undergoing CAS were selected in the hospital. The level of serum hs-CRP of pre-operation and 1d,7d,3 mon and 6 mon post-operation was measured. The relationship was analyzed between serum hs-CRP level and the degree of stenosis and restenosis following CAS. Results The incidence of carotid stenosis increased with the level of serum hs-CRP (P<0.05) before operation. The incidence of restenosis was 19.05%(32/168) after 6 months of operation. No difference of the serum hs-CRP level was noted at pre-operation and 1d post-operation between the patients of restenosis and non-restenosis (P>0.05). The serum hs-CRP level in the patients of restenosis was significantly higher than that in those of non-restenosis on 7 d,3 mon and 6 mon post-operation,while the patients of nonrestenosis had a higher level of △hs-CRP than those of restenosis (P<0.05). The serum hs-CRP level in all the patients increased significantly on day 1 after surgery,and it remained a high level after 7d of surgery in the patients of restenosis compared with those of pre-operation. However,the hs-CRP level was significantly decreased in the patients of no-restenosis (P<0.05). Multivariate regression analysis showed that △hs-CRP was an independent risk factor for restenosis after CAS. Conclusion The remarkable increase of serum hs-CRP was positively associated with the carotid stenosis following CAS, suggesting a predict marker for carotid artery restenosis.