血清sTREM-1对下肢动脉硬化闭塞症支架植入术后血管再狭窄的预测价值

Value of serum sTREM-1 in predicting vascular restenosis after stent implantation in patients with lower extremity arteriosclerosis obliterans

目的探讨血清可溶性髓系细胞触发受体1(sTREM-1)对下肢动脉硬化闭塞症(LASO)支架植入术后血管再狭窄的预测价值。方法选择行支架植入术的LASO患者206例,术后随访1年,根据随访期间是否发生血管再狭窄将患者分为再狭窄组79例、未狭窄组127例。收集所有患者入院时人口学资料(包括性别、年龄、BMI、吸烟史、高血压史、糖尿病史、高脂血症史、冠心病史及血压)、实验室检查资料[包括空腹血糖(FPG)、TC、TG、HDL-C、LDL-C、sTREM-1]及下肢病变资料(包括下肢血管病变长度和双侧下肢血管病变、下肢血管完全闭塞例数)。采用多因素非条件Logistic回归模型分析LASO支架植入术后血管再狭窄的危险因素。采用受试者工作特征(ROC)曲线评估血清sTREM-1预测LASO支架植入术后血管再狭窄的效能。结果人口学资料共纳入10个因素,两组BMI及有吸烟史、高血压史、糖尿病史、高脂血症史、冠心病史例数比较P均<0.05,性别、年龄、BMI、收缩压、舒张压比较P均>0.05。两组实验室检查资料共纳入6个因素,两组LDL-C、sTREM-1比较P均<0.05,FPG、TC、TG、HDL-C比较P均>0.05。下肢病变资料共纳入3个因素,两组下肢血管病变长度及双侧下肢血管病变、下肢血管完全闭塞例数比较P均<0.05。多因素非条件Logistic回归模型分析显示,高血压史、高脂血症史、冠心病史,血清sTREM-1及下肢血管病变长度、下肢血管完全闭塞是LASO支架植入术后血管再狭窄的独立危险因素(P均<0.05)。ROC曲线分析显示,血清sTREM-1预测LASO支架植入术后血管再狭窄的曲线下面积为0.939(95%CI:0.901~0.978),其cut off值为289.51 ng/L,此时其预测LASO支架植入术后血管再狭窄的敏感性为86%、特异性为93%、准确性为89%。结论血清sTREM-1是LASO支架植入术后血管再狭窄的独立危险因素,有望成为预测LASO支架植入术后血管再狭窄的血清生化指标。

Objective To explore the predictive value of soluble triggering receptor expressed on myeloid cells-1(sTREM-1)for vascular restenosis after stent implantation in patients with lower extremity arteriosclerosis obliterans(LASO).Methods Totally 206 patients with LASO who received stent implantation were followed up for one year.According to whether vascular restenosis occurred during the follow-up,the patients were divided into the restenosis group of 79 cases and non-stenosis group of 127 cases.The demographic data(including gender,age,BMI,smoking history,hypertension history,diabetes history,hyperlipidemia history,coronary heart disease history and blood pressure),laboratory examination data(including serum FPG,TC,TG,HDL-C,LDL-C,sTREM-1),and data on lower extremity lesions(including the length of lower extremity vascular lesions and bilateral lower extremity vascular lesions,the number of cases with complete occlusion of blood vessels of lower extremity)were collected.The risk factors of restenosis after stent implantation were analyzed by multivariate unconditional Logistic regression model.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy of serum sTREM-1 in predicting restenosis after stent implantation.Results Ten factors were included in the demographic data.Significant differences were found in the BMI and the number of cases with smoking history,hypertension history,diabetes history,hyperlipidemia history and coronary heart disease history(all P<0.05),but no significant differences were found in the gender,age,BMI,systolic blood pressure or diastolic blood pressure(all P>0.05).Ten factors were included in the laboratory examination data of the two groups.Significant differences were found in the LDL-C and sTREM-1 between the two groups(both P<0.05),while no significant differences were found in the FPG,TC,TG or HDL-C(all P<0.05).Meanwhile,significant differences were found in the length of lower extremity vascular lesions,bilateral lower extremity vascular lesions,and the number of cases with complete occlusion of blood vessels of lower extremity between the two groups(all P<0.05).Multivariate analysis of the unconditional Logistic regression model showed that hypertension history,hyperlipidemia and coronary heart disease history,serum sTREM-1,length of lower limb vascular lesions and complete occlusion of lower limb vessels were independent risk factors for restenosis after stent implantation(all P<0.05).ROC curve analysis showed that the area under the curve of serum sTREM-1 in predicting vascular restenosis after implantation of LASO was 0.939(95%CI:0.901-0.978),and its cut-off value was 289.51 ng/L,with the sensitivity,specificity and accuracy of 86%,93%,and 89%,respectively.Conclusion Serum sTREM-1 is an independent risk factor for vascular restenosis after LASO stent implantation,and is expected to be a serum biochemical indicator to predict restenosis after LASO stent implantation.