血小板膜标志物表达水平与颈动脉粥样硬化病人支架内再狭窄的关系

Correlation between the expression of platelet membrane markers and in-stent restenosis in the elderly patients with carotid artery disease

目的探讨血小板膜标志物α颗粒膜糖蛋白(CD62p)及溶酶体膜蛋白(CD63)的表达水平与颈动脉粥样硬化(CAS)病人支架内再狭窄(ISR)的关系。方法选取2015年10月至2017年6月于我院确诊为CAS行颈动脉支架成形术且临床资料完整的病人106例,根据复查颈动脉数字减影血管造影(DSA)的结果分为ISR组16例和无支架内再狭窄(NISR)组90例。比较2组病人性别、年龄等一般资料及术前狭窄程度、术后有无残余狭窄、术后抗血小板药物应用依从性、术前及术后1个月CD62p及CD63的表达率,对2组差异有统计学意义的因素进行多因素Logistic回归分析。使用ROC分析术后1个月CD62p及CD63的表达率对支架成形术后ISR的预测价值。结果单因素分析结果显示,2组在吸烟史、高血压、DM、支架数量、术后残余狭窄、术后抗血小板药物应用依从性、术后1个月CD62p及CD63的表达率方面差异均有统计学意义(P<0.05);多因素Logistic回归分析显示,支架数量(OR=3.377,95%CI1.460~7.814)、术后残余狭窄(OR=3.827,95%CI1.373~10.666)、术后1个月CD62p的表达率(OR=3.758,95%CI2.752~5.133)、术后1个月CD63的表达率(OR=6.209,95%CI2.121~18.176)是术后ISR的独立危险因素。ROC分析显示,以术后1个月CD62p的表达率>5.43%为切点,其预测术后ISR的灵敏度为88.42%,特异度为76.27%,AUC为0.892;术后1个月CD63的表达率>8.13%作为最佳切点,预测ISR灵敏度为77.34%,特异度为90.68%,AUC为0.824。结论术后1个月血小板膜标志物CD62p、CD63的表达水平与ISR密切相关,可协助预测颈动脉支架成形术后ISR的风险。

Objective To explore the relationship of the expression of alpha granular membrane glycoprotein(CD62p)and lysosomal membrane protein(CD63)with in-stent restenosis(ISR)in the elderly patients with carotid artery atherosclerosis(CAS).Methods From October 2015 to June 2017,106 elderly patients with carotid atherosclerosis who underwent carotid artery stenting and had complete clinical data were selected.According to the results of carotid digital subtraction angiography(DSA),16 patients were divided into ISR group and 90 patients were divided into non-stent restenosis(NISR)group.The general data of gender,age,the degree of preoperative stenosis,residual stenosis after operation,the compliance of antiplatelet treatment after operation,the expression of CD62p and CD63 before and 1 month after operation were compared between two groups.Multivariate Logistic analysis was used to analyze the risk factors of ISR.The ROC was used to analyze the predictive value of the expression rates of CD62p and CD631 month after operation for the ISR.Results Smoking history,hypertension,diabetes mellitus,number of stents,residual stenosis after operation,postoperative antiplatelet drug compliance,expression rates of CD62p and CD631 month after operation were significantly different betweent two groups(P<0.05).Logistic regression analysis showed that the number of stents(OR=3.377,95%CI 1.460-7.814),residual stenosis after operation(OR=3.827,95%CI 1.373-10.666),CD62p expression rate 1 month after operation(OR=3.758,95%CI2.752-5.133)and CD63 expression rate 1 month after operation(OR=6.209,95%CI2.121-18.176)were independent risk factors for ISR.ROC analysis showed that the expression rate of CD62p 1 month after operation>5.43%was the cut-off point,with a sensitivity of 88.42%and a specificity of 76.27%for ISR,and area under ROC(AUC)was 0.892;The expression rate of CD631 month after operation>8.13%was the cut-off point,with a sensitivity of 77.34%and a specificity of 90.68%for ISR,and AUC was 0.824.Conclusions The expression levels of platelet membrane markers CD62p and CD631 month after operation are closely related to ISR,which can help to predict the risk of ISR.