冠状动脉慢性完全闭塞患者单核细胞趋化因子1的表达及其对侧支循环形成的影响

Expression of monocyte chemoattractant protein-1 in patients with coronary artery chronic total occlusion and its effect on the collateral circulation formation

目的探讨单核细胞趋化因子1(monocyte chemoattractant protein-1,MCP-1)在冠状动脉(简称冠脉)慢性完全闭塞(chronic total occlusion,CTO)患者的表达及其对侧支循环形成的影响。方法选择80例行冠脉造影术提示冠脉CTO病变患者,根据冠脉造影术中侧支循环级别水平(0~3级),分为侧支循环良好组(Rentrop分级2~3级)40例,侧支循环不良组(Rentrop分级0~1级)40例。冠脉造影术后、PCI术前采集所有患者静脉血,通过酶联免疫吸附法(enzyme linked immunosorbent assay,ELISA)方法测量血浆MCP-1水平。通过多因素logistic回归分析判定CTO患者侧支循环形成的促进因素;采用ROC曲线界定MCP-1的cut off值评价其预测侧支循环价值。结果(1)侧支循环良好组MCP-1浓度(118.13±16.24)pg/mL与侧支循环不良组(81.80±15.40)pg/mL比较,差异有统计学意义(P=0.036)。(2)多因素logistic回归分析提示MCP-1水平是侧支循环形成促进因素(OR=0.882,95%CI 0.839~0.928,P<0.001)。以MCP-1值=103.00 pg/mL为cut off值,特异度为85.00%,敏感度为95.00%,ROC曲线下面积为0.940(95%CI 0.889~0.995,P<0.001)。结论MCP-1在冠脉CTO患者中表达存在差异,在侧支循环良好组患者表达高,提示MCP-1有利于该类患者侧支循环的建立。

Objective To investigate the expression of monocyte chemoattractant protein-1(MCP-1)in patients with coronary artery chronic total occlusion(CTO),and its effect on collateral circulation formation.Methods Patients with coronary artery CTO diagnosed by coronary angiography were divided into two groups according to the grade of collateral circulation,good collateral circulation group(Rentrop Grade 2-3)and poor collateral circulation group(Rentrop Grade 0-1).Venous blood samples were collected from all patients after coronary angiography and before PCI;and plasma MCP-1 levels were measured by enzyme linked immunosorbent assay.Multivariate logistic regression analysis was used to determine the factors promoting the formation of collateral circulation in patients with CTO,and ROC curve was used to define the cutoff value of MCP-1 to evaluate its predictive value of collateral circulation.Results The concentration of MCP-1 in good collateral circulation group was significantly higher than that in poor collateral circulation group[(118.13±16.24)pg/mL vs.(81.80±15.40)pg/mL,P=0.036].Multivariate logistic regression analysis showed that the level of MCP-1 was the promoting factor for the formation of collateral circulation(OR=0.882,95%CI:0.839-0.928,P<0.001).Taking the MCP-1 value of 103.00 pg/mL as the cut off value,the specificity was 85.00%,the sensitivity was 95.00%,and the area under the ROC curve was 0.940(95%CI:0.889-0.995,P<0.001)for predicting the formation of collateral circulation.Conclusion There is difference in the expression of MCP-1 in patients with coronary artery CTO,and the expression is high in patients with good collateral circulation,suggesting that MCP-1 is beneficial to the establishment of collateral circulation.