冠状动脉性心脏病患者经皮冠状动脉介入治疗后脑源性神经营养因子和肾胺酶水平变化及意义

Changes of brain-derived neurotrophic factor and renalase levels in patients with coronary heart disease after percutaneous coronary intervention and their clinical significance

目的探讨冠状动脉性心脏病(冠心病)患者皮冠状动脉介入治疗(PCI)后血清脑源性神经营养因子(BDNF)和肾胺酶(renalase)水平与预后的关系。方法选择2015年5月至2016年5月在驻马店市第一人民医院接受PCI的128例冠心病患者作为研究对象。采用酶联免疫吸附试验(ELISA)检测冠心病患者PCI术前、术后血清BDNF、肾胺酶水平。采用受试者工作特征曲线(ROC)评价BDNF和肾胺酶预测患者预后效能。Cox单因素和多因素分析影响患者预后不良因素。结果冠心病患者PCI术后血清肾胺酶水平低于术前,低于对照组,差异均有统计学意义(P<0.05)。128例冠心病患者中预后不良16.4%(21/128),预后良好组与预后不良组患者血清BDNF水平差异无统计学意义(P>0.05),肾胺酶水平低于预后不良组(P<0.05)。血清肾胺酶预测冠心病患者预后的ROC曲线下面积(AUC)为0.937,显著高于BDNF预测冠心病患者预后AUC(Z=5.627,P<0.001)。肾胺酶>38.96 ng/mL冠心病患者平均主要心血管不良事件(MACE)未发生时间,显著低于肾胺酶≤38.96 ng/mL冠心病患者(χ~2=65.561,P<0.001)。Cox单因素和多因素分析结果表明,年龄、肾胺酶水平、伴慢性阻塞性肺疾病与冠心病患者PCI术后预后密切相关。结论冠心病患者PCI术后血清肾胺酶水平与预后密切相关。检测血清肾胺酶水平有助于评估患者预后。

Objective To investigate the correlation of serum levels of brain-derived neurotrophic factor(BDNF)and renalase with the prognosis in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI).Methods A total of 128 CHD patients,who underwent PCI at the Zhumadian Municipal First People’s Hospital of China during the period from May 2015 to May 2016,were enrolled in this study.By using enzyme linked immunosorbent assay(ELISA),the serum BDNF and renalase levels were measured before and after PCI in all patients.The receiver operating characteristic curve(ROC)was used to evaluate the prognostic effectiveness of serum BDNF and renalase levels.Cox univariate and multivariate analysis was adopted to analyze the adverse prognostic factors.Results The post-PCI serum renalase level in CHD patients was lower than that of the pre-PCI value as well as lower than that in the control group,and the difference was statistically significant(P<0.05).Of 128 CHD patients,poor prognosis was seen in 21 patients(16.4%),and no statistically significant difference in serum BDNF level existed between good prognosis group and poor prognosis group(P>0.05).The serum renalase level in good prognosis group was lower than that in poor prognosis group(P<0.05).For predicting CHD patients’prognosis,the area under ROC curve(AUC)of serum renalase was 0.937,which was remarkably higher than that of serum BDNF(Z=5.627,P<0.001).The mean free-MACE(major adverse cardiovascular events)time in CHD patients with a serum renalase level>38.96 ng/mL was strikingly shorter than that in CHD patients with a serum renalase level≤38.96 ng/mL(χ~2=65.561,P<0.001).Cox univariate and multivariate analysis showed that age,renalase level and coxisting chronic obstructive pulmonary disease were closely related to the prognosis of CHD patients after PCI.Conclusion The post-PCI serum renalase levels in patients with CHD are closely related to the prognosis.Therefore,the detection of serum renalase levels after PCI in CHD patients is helpful for predicting the prognosis.(J Intervent Radiol,2020,29:698-702)