联合检测三项血清学指标对ACS患者PCI术后支架内再狭窄的预测作用

Predictive Value of Combined Detection of Three Serological Indicators for In-Stent Restenosis in Patients with ACS after PCI

目的探讨脂蛋白相关性磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)、血清淀粉样蛋白A(serum amyloid A,SAA)、可溶性髓系细胞触发受体1(soluble triggering receptor expressed on myeloid cells-1,sTREM-1)联合检测对急性冠脉综合征(acute coronary syndrome,ACS)患者经皮冠脉介入术(percutaneous coronary intervention,PCI)后支架内再狭窄(in-stent restenosis,ISR)的预测作用。方法回顾分析2012年1月至2019年12月接受首次PCI治疗的ACS患者344例。根据患者PCI术后1年冠脉造影是否发生ISR,将患者分为再狭窄组(n=48)和非再狭窄组(n=296)。比较两组一般资料及实验室相关指标,采用逐步多元logistic回归分析PCI术后发生ISR危险因素,采用受试者操作特征(receiver operating characteristic,ROC)曲线评估Lp-PLA2、SAA、sTREM-1对ACS患者PCI术后发生ISR的预测效能。结果再狭窄组ST段抬高心肌梗死(ST segment elevation myocardial infarction,STEMI)比例、吸烟比例、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)水平、糖化血红蛋白(glycosylated hemoglobin,HbA1c)水平、支架数目、分叉术式和支架串联比例高于非再狭窄组(P<0.05)。再狭窄组患者Lp-PLA2[(351.93±110.40)ng/ml vs(267.18±97.13)ng/ml)]、SAA[(19.83±4.39)mg/L vs(12.06±2.67)mg/L]、sTREM-1[(319.71±96.38)ng/L vs(238.92±80.35)ng/L]水平高于非再狭窄组(P<0.05)。STEMI、LDL-C、HbA1c未达标及Lp-PLA2、SAA、sTREM-1高表达、分叉术式是PCI术后发生ISR的独立危险因素(P<0.05)。以Lp-PLA2310.65 ng/ml、SAA 14.86 mg/L、sTREM-1293.79 ng/L为截断值,LpPLA2、SAA、sTREM-1联合诊断ACS的曲线下面积(area under the curve,AUC)为0.859,高于各指标单独诊断的AUC(Z=5.361,P<0.05)。结论ACS患者PCI术后ISR的发生与术后Lp-PLA2、SAA、sTREM-1高水平相关,联合检测可提升对ISR预测效能。

Objective To investigate the predictive value of lipoprotein-associated phospholipase A2(Lp-PLA2),serum amyloid A(SAA)and soluble triggering receptor expressed on myeloid cells-1(sTREM-1)for in-stent restenosis(ISR)in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods Retrospective analysis was conducted on 344 patients with ACS who received initial PCI treatment from January 2012 to December 2019.The patients were divided into restenosis group(n=48)and non-restenosis group(n=296)according to whether ISR detected by coronary angiography 1 year after PCI.General data and laboratory indicators of the two groups were compared.Risk factors for ISR after PCI were analyzed by stepwise multiple logistic regression.Receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of Lp-PLA2,SAA and sTREM-1 for ISR after PCI in patients with ACS.Results ST segment elevation myocardial infarction(STEMI)proportion,smoking proportion,low density lipoprotein-cholesterol(LDL-C)level,glycosylated hemoglobin(HbA1c)level,stent number,ratio of bifurcation operation and stent series in restenosis group were higher than those in non-restenosis group(P<0.05).The levels of Lp-PLA2[(351.93±110.40)ng/ml vs(267.18±97.13)ng/ml)],SAA[(19.83±4.39)mg/L vs(12.06±2.67)mg/L]and sTREM-1[(319.71±96.38)ng/L vs(238.92±80.35)ng/L]in the restenosis group were higher than those in the non-restenosis group(P<0.05).STEMI,LDL-C,Hb A1c,bifurcation operation,Lp-PLA2,SAA and s TREM-1 were independent risk factors for ISR after PCI(P<0.05).Using LpPLA2310.65 ng/ml,SAA 14.86 mg/L and s TREM-1293.79 ng/L as the cutoff values,the area under the curve(AUC)of combined diagnosis of Lp-PLA2,SAA and s TREM-1 was 0.859,which was higher than that of single diagnosis of each index(Z=5.361,P<0.05).Conclusions The occurrence of ISR after PCI in ACS patients is correlated with the high levels of Lp-PLA2,SAA and s TREM-1 after PCI,and the combined detection can improve the prediction efficiency of ISR.