下肢动脉硬化闭塞症患者外周血单个核细胞中CBX3水平与介入术后1年内支架内再狭窄的关系

Relationship between CBX3 level in peripheral blood mononuclear cells and in-stent restenosis in patients with lower extremity arteriosclerosis obliterans within one year after intervention

目的探究下肢动脉硬化闭塞症(LASO)患者外周血单个核细胞中色素框同源蛋白3(CBX3)水平与介入术后1年内支架内再狭窄(ISR)关系。方法选择2018年4月至2019年5月在华北理工大学附属医院确诊的LASO患者204例。根据LASO患者介入术后1年内是否发生ISR将其分为狭窄组(n=69)和未狭窄组(n=135)。Ficoll密度梯度离心法分离外周血中单个核细胞。蛋白质免疫印迹法检测单个核细胞中CBX3蛋白水平。结果狭窄组介入术前、术后7 d和14 d外周血单个核细胞中CBX3蛋白水平分别为0.67±0.12,0.72±0.12和0.77±0.06。未狭窄组介入术前、术后7 d和14 d外周血单个核细胞中CBX3蛋白水平分别为0.68±0.11,0.78±0.13和0.96±0.08。狭窄组和未狭窄组外周血单个核细胞中CBX3蛋白比较,差异有时间效应、组间效应及时间和组间的交互效应(P<0.05)。术后14 d外周血单个核细胞中CBX3蛋白诊断ISR的ROC曲线下面积(AUC)、敏感度和特异度分别为0.949,89.9%和87.4%,其诊断ISR的效能高于术前和术后7 d外周血单个核细胞中CBX3蛋白,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,血管闭塞长度和完全闭塞是LASO患者ISR的独立危险因素(P<0.05),术后14 d CBX3是LASO患者ISR的独立保护因素(P<0.05)。限制性立方样条拟合Logistic回归分析结果显示,外周血单个核细胞中CBX3蛋白与LASO患者ISR有关(P<0.05),且呈线性关系(非线性检验P>0.05)。结论LASO患者介入术后14 d外周血单个核细胞中CBX3蛋白水平低提示1年内发生ISR的风险高。

Objective To explore the relationship between the level of chromobox protein homolog 3(CBX3)in peripheral blood mononuclear cells and in-stent restenosis(ISR)in patients with lower extremity arteriosclerosis obliterans(LASO)within 1 year after intervention.Methods A total of 204 patients with LASO admitted to North China University of Science and Technology Affiliated Hospital from April 2018 to May 2019 were selected as study subjects.LASO patients were divided into 2 groups according to the occurrence of ISR within 1 year after intervention:stenosis group(n=69)and non-stenosis group(n=135).Ficoll density gradient centrifugation was used to isolate mononuclear cells in peripheral blood.Western blot was used to detect the level of CBX3 protein in mononuclear cells.Results The levels of CBX3 in peripheral blood mononuclear cells in stenosis group were 0.67±0.12,0.72±0.12 and 0.77±0.06 before the operation,7 d and 14 d after the operation,respectively.The levels of CBX3 in peripheral blood mononuclear cells in non-stenosis group were 0.68±0.11,0.78±0.13 and 0.96±0.08 before the operation,7 d and 14 d after the operation,respectively.The difference of CBX3 protein in the peripheral blood mononuclear cells in stenosis group and non-stenosis group showed time effect,inter-group effect and time and inter-group interaction effect(P<0.05).The area under the ROC curve(AUC),sensitivity,and specificity of CBX3 protein in the diagnosis of ISR in peripheral blood mononuclear cells at 14 d after surgery were 0.949,89.9%,and 87.4%,respectively,and the efficacy of diagnosing ISR was higher than that before surgery and 7 d after surgery(P<0.05).Multivariate Logistic regression analysis showed that the vascular occlusion length and the complete occlusion were independent risk factors for ISR in LASO patients(P<0.05).CBX3 at 14 d after surgery was an independent protective factor for ISR in LASO patients(P<0.05).Restricted cubic spline fitting Logistic regression analysis showed that CBX3 protein in peripheral blood mononuclear cells was related to ISR of LASO patients(P<0.05),and showed a linear relationship(non-linear test P>0.05).Conclusion The low level of CBX3 protein in the peripheral blood mononuclear cells at 14 d after surgery suggests that LASO patients have a high risk of ISR within 1 year after intervention.