血浆ET-1、TNF-α、sICAM-1浓度与PCI治疗后患者心肌损伤的关系

Relationships between plasma concentrations of ET-1,TNF-α,sICAM-1 with myocardial injury in pa⁃tients after percutaneous coronary intervention

目的检测冠状动脉粥样硬化性心脏病(冠心病)患者血清内皮素-1(endothelin-1,ET-1)、肿瘤坏死因子(tumor necrosis factor-α,TNF-α)、可溶性细胞间黏附分子-1(soluble intercellular adhesion molecule-1,sICAM)浓度,并分析经皮冠状动脉介入(percutaneous coronary intervention,PCI)前血清ET-1、TNF-α、sICAM-1浓度与PCI治疗后心肌损伤的关系。方法选取2017年1月至2019年1月在邯郸市第一医院住院并行PCI治疗的冠心病患者102例为研究对象,根据PCI治疗后患者结局分为PCI治疗后心肌损伤组(n=22)和PCI治疗后心肌未损伤组(n=80)。采用酶联免疫吸附测定法(ELISA)检测所有研究对象PCI治疗前、PCI治疗后血清ET-1、TNF-α、sICAM-1浓度,采用生化分析仪检测血清心肌肌钙蛋白(cardiac troponin I,cTnI)、肌酸激酶同工酶(creatine kinase isoenzyme,CKMB)浓度。结果心肌损伤组患者PCI治疗前血清ET-1、TNF-α、sICAM-1浓度显著高于PCI治疗后,差异有统计学意义(P<0.05);心肌未损伤组患者PCI治疗前血清ET-1、TNF-α、sICAM-1浓度与PCI治疗后比较,差异无统计学意义(P>0.05)。心肌损伤组PCI治疗前与PCI治疗后血清ET-1、TNF-α、sICAM-1浓度均显著高于心肌未损伤组,差异有统计学意义(P<0.05)。PCI治疗后,心肌损伤组患者血清cTnI、CKMB浓度显著高于PCI治疗前及心肌未损伤组,差异有统计学意义(P<0.05);PCI治疗前,心肌损伤组血清cTnI、CKMB浓度与心肌未损伤组比较,差异无统计学意义(P>0.05)。PCI治疗前患者血清ET-1、TNF-α、sICAM-1浓度与PCI治疗后血清cTnI、CKMB浓度呈正相关(P<0.05)。患者PCI治疗前血清ET-1、TNF-α、sICAM-1浓度单独检测对PCI治疗后心肌损伤具有一定诊断价值,3者联合检测的曲线下面积为0.932,敏感度为87.90%,特异度为92.90%。Logistic回归分析结果显示,PCI治疗前血清ET-1、TNF-α、sICAM-1浓度是PCI治疗后心肌损伤的危险因素(P<0.05)。结论患者PCI治疗前ET-1、TNF-α、sICAM-1浓度升高,可能作为PCI治疗后心肌损伤的分子标记物。

Objectives To detect the plasma concentrations of endothelin-1(ET-1),tumor necrosis factor-α(TNF-α),soluble intercellular adhesion molecule-1(sICAM)in patients with coronary heart disease(CHD),and to analyze the relationships between the pre-percutaneous coronary intervention(PCI)plasma concentrations of ET-1,TNF-α,sICAM-1 with myocardial injury after PCI.Methods Totally 102 patients with CHD who underwent PCI in Handan First Hospital from January 2017 to January 2019 were selected as study objects.According to the post-PCI outcomes of the patients,they were divided into post-PCI myocardial injury group(n=22)and post-PCI non-myocardial injury group(n=80).Plasma concentrations of ET-1,TNF-α and sICAM-1 were detected by enzyme-linked immunosorbent assay(ELISA)before and after PCI.Serum concentrations of troponin I(cTnI)and creatine kinase isoenzyme(CKMB)were detected by biochemical analyzer.Results Plasma concentrations of ET-1,TNF-α and sICAM-1 in patients with myocardial injury before PCI were significantly higher than those after PCI(P<0.05).There were no significant differences of plasma concentrations of ET-1,TNF-α and sICAM-1 in non-myocardial injury group before and after PCI(P>0.05).Plasma concentrations of ET-1,TNF-α and sICAM-1 in patients with myocardial injury before and after PCI were significantly higher than those in non-myocardial injury group(P<0.05).After PCI,serum concentrations of cTnI and CKMB in myocardial injury group were significantly higher than those before PCI and in nonmyocardial injury group(P<0.05).There were no significant differences in serum concentrations of cTnI and CKMB between the two groups before PCI(P>0.05).Plasma concentrations of ET-1,TNF-α and sICAM-1 before PCI positively associated with serum concentrations of cTnI and CKMB after PCI.Pre-PCI plasma concentrations of ET-1,TNF-α and sICAM-1 had certain diagnostic value for myocardial injury after PCI.Area under the curve(AUC)of combined plasma concentrations of ET-1,TNF-αand sICAM-1 detection was 0.932,of which the sensitivity was 87.90% and the specificity was 92.90%.Logistic regression analysis showed that pre-PCI plasma concentrations of ET-1,TNF-α,and sICAM-1 were risk factors for myocardial injury after PCI(P<0.05).Conclusions Plasma concentrations of ET-1 of TNF-α and sICAM-1 increases before PCI.Plasma concentrations of ET-1,TNF-αand sICAM-1 may be molecular markers of myocardial injury in patients after PCI.