不同指标对老年下肢动脉闭塞症患者支架植入术后再狭窄的诊断价值

Diagnostic Values of Different Indicators for Restenosis after Stent Implantation in Patients with Lower Extremity Arterial Occlusive Disease

目的探讨微小RNA(miR)-143、C反应蛋白(CRP)、一氧化氮(NO)在老年下肢动脉闭塞症患者支架植入术后再狭窄中的诊断价值。方法选取2015年2月~2019年1月河北医科大学第二医院收治的下肢动脉闭塞症患者178例作为研究对象,根据下肢支架植入术后9个月再狭窄发生情况分为再狭窄组47例和无再狭窄组131例。比较两组术前1天血糖、血脂、总胆红素(TBIL)、直接胆红素(DBIL)及血中miR-143、CRP、NO水平,并进行再狭窄的预测分析。结果两组术前1天的血糖、血脂比较,差异均无统计学意义(P>0.05);再狭窄组的TBIL、DBIL及血清NO水平低于无再狭窄组,miR-143相对表达水平及CRP表达水平均高于无再狭窄组,差异均有统计学意义(P<0.05)。多因素二元logistic回归分析显示miR-143、CRP为下肢动脉闭塞症患者支架植入术后再狭窄发生的独立危险因素(P<0.05),DBIL为其保护因素(P<0.05)。miR-143、CRP、NO对下肢动脉闭塞症患者支架植入术后再狭窄的ROC曲线下面积分别为0.794(95%CI:0.720~0.868,cut off值为4.425)、0.957(95%CI:0.915~0.999,cut off值为9.345 mg/L)、0.774(95%CI:0.691~0.856,cut off值为28.571μmol/L)。结论老年下肢动脉闭塞症患者支架植入术后再狭窄比较常见,术前检测miR-143、CRP、NO水平对于预测血管再狭窄的发生可能具有重要价值。

Objective To investigate the values of microRNA-143(miR-143),C-reactive protein(CRP)and nitric oxide(NO)in the diagnosis of restenosis after stent implantation in older patients with lower extremity arterial occlusive disease(LEAOD).Methods A total of 178 older patients with LEAOD admitted to hospital from February 2015 to January 2019 were enrolled in this study.All patients underwent stent implantation.According to the presence of restenosis within 9 months after operation,the patients were assigned into a restenosis group(47 cases)and a restenosis-free group(131 cases).The levels of blood glucose,blood lipid,total bilirubin(TBIL),direct bilirubin(DBIL),miR-143,CRP and NO at 1 day before surgery were compared between the two groups.Prediction analysis for restenosis was performed.Results There were no significant differences in the blood glucose level and blood lipid level between the two groups at 1 day before operation(P>0.05).The levels of TBIL,DBIL and NO in the restenosis group were lower than those in the restenosis-free group,while the relative expression level of miR-143 and CRP level in the restenosis group were higher than those in the restenosis-free group,the differences were statistically significant between the two groups(P<0.05).Multivariate binary logistic regression analysis showed that miR-143 and CRP were independent risk factors for restenosis after stent implantation in patients with LEAOD(P<0.05),and DBIL was the protective factor(P<0.05).The areas under receiver operating characteristic(ROC)curve of miR-143,CRP and NO for restenosis were 0.794(95%CI:0.720-0.868,cut off value:4.425),0.957(95%CI:0.915-0.999,cut off value:9.345 mg/L)and 0.774(95%CI:0.691-0.856,cut off value:28.571μmol/L),respectively.Conclusion Restenosis after stent implantation is common in older patients with LEAOD.Preoperative determination of miR-143,CRP and NO may have important value in predicting the occurrence of restenosis.