血清淀粉样蛋白A联合胱抑素C、脂蛋白a对冠心病患者经皮冠状动脉介入治疗后冠状动脉再狭窄的预测价值

Predictive value of SAA combined with Cys C and Lp(a)for coronary restenosis after PCI in patients with coronary heart disease

目的探讨血清淀粉样蛋白A(SAA)联合胱抑素C(Cys C)、血清脂蛋白(a)[Lp(a)]对冠心病(CHD)患者经皮冠状动脉介入治疗(PCI)后冠状动脉再狭窄的预测价值。方法选择2019年2月至2022年2月期间在湖北省鄂钢医院心血管内科住院行PCI治疗的184例CHD患者作为研究对象,根据PCI术后6个月内是否出现冠状动脉再狭窄分为未狭窄组(145例)和再狭窄组(39例),其中男96例,女88例,年龄(65.1±7.7)岁。比较两组患者性别、年龄、体质量指数(BMI)、吸烟史、饮酒史、基础性疾病(高血压、糖尿病、高血脂、脑卒中)、术前冠状动脉狭窄程度、支架长度、支架直径等资料;患者入院时,采用免疫比浊法检测血清SAA、Cys C、Lp(a)水平,采用全自动血生化仪检测血脂指标[总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)],采用超声心动图监测患者左心房内径(LAD)和左心室射血分数(LVEF),采用冠状动脉造影术(CAG)判断冠状动脉发生病变的具体位置。采用多元logistic回归方程分析CHD患者PCI后冠状动脉再狭窄发生的危险因素,采用受试者工作特征曲线(ROC)分析SAA联合Cys C、Lp(a)对CHD患者PCI后冠状动脉再狭窄的预测价值。统计学方法采用χ^(2)检验、独立样本t检验。结果再狭窄组与未狭窄组在SAA[(18.15±4.28)mg/L比(13.86±2.25)mg/L]、Cys C[(1.82±0.34)mg/L比(1.43±0.26)mg/L]、Lp(a)[(2.11±0.31)g/L比(1.80±0.28)g/L]、LDL-C[(2.73±0.65)mmol/L比(2.25±0.51)mmol/L]、LAD[(55.73±7.47)mm比(48.51±5.62)mm]、LVEF[(39.77±4.51)%比(45.02±5.92)%]、术前冠状动脉狭窄程度[(93.17±3.78)%比(90.06±3.54)%]方面比较差异均有统计学意义(均P<0.001);SAA、Cys C、Lp(a)表达水平过高、LVEF过低、术前冠状动脉狭窄程度严重均为CHD患者PCI后发生冠状动脉再狭窄的危险因素(均P<0.05);SAA联合Cys C、Lp(a)预测CHD患者PCI后冠状动脉再狭窄的曲线下面积(AUC)、灵敏度及特异度均优于单一指标检测(均P<0.05)。结论SAA联合Cys C、Lp(a)预测CHD患者PCI后冠状动脉再狭窄具有较好的临床价值。

Objective To investigate the predictive value of serum amyloid A(SAA)combined with cystatin C(Cys C)and serum lipoprotein(a)[Lp(a)]for coronary restenosis after percutaneous coronary intervention(PCI)in patients with coronary heart disease(CHD).Methods A total of 184 CHD patients were divided into a non-stenosis group(145 cases)and a restenosis group(39 cases)according to whether coronary restenosis occurred within six months after PCI,including 96 males and 88 females,aged(65.1±7.7)years.The gender,age,body mass index(BMI),smoking history,drinking history,underlying diseases(hypertension,diabetes,hyperlipidemia,and stroke),preoperative degree of coronary artery stenosis,stent length,and stent diameter were compared between the two groups.At admission,the levels of SAA,Cys C,and Lp(a)in serum were detected by immunoturbidimetry;the blood lipid indexes[total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),and high density lipoprotein cholesterol(HDL-C)]were detected by automatic blood biochemical analyzer;the left atrial diameter(LAD)and left ventricular ejection fraction(LVEF)were measured by echocardiography;the specific locations of coronary artery lesions were determined by coronary angiography(CAG).Multiple logistic regression equation was used to analyze the risk factors of coronary restenosis in patients with CHD after PCI.The receiver operating characteristic curve(ROC)was used to analyze the predictive value of SAA combined with Cys C and Lp(a)for coronary restenosis in patients with CHD after PCI.χ^(2) test and independent sample t test were used.Results There were statistically significant differences in the SAA[(18.15±4.28)mg/L vs.(13.86±2.25)mg/L],Cys C[(1.82±0.34)mg/L vs.(1.43±0.26)mg/L],Lp(a)[(2.11±0.31)g/L vs.(1.80±0.28)g/L],LDL-C[(2.73±0.65)mmol/L vs.(2.25±0.51)mmol/L],LAD[(55.73±7.47)mm vs.(48.51±5.62)mm],LVEF[(39.77±4.51)%vs.(45.02±5.92)%],and preoperative degree of coronary artery stenosis[(93.17±3.78)%vs.(90.06±3.54)%]between the restenosis group and the non-stenosis group(all P<0.001).High expressions of SAA,Cys C,and Lp(a),low LVEF,and severe preoperative coronary artery stenosis were all risk factors for coronary restenosis after PCI in CHD patients(all P<0.05).The area under the curve(AUC),sensitivity,and specificity of SAA combined with Cys C and Lp(a)in predicting coronary restenosis after PCI in CHD patients were better than those of single index(all P<0.05).Conclusion SAA combined with Cys C and Lp(a)has a good clinical value in predicting coronary restenosis in CHD patients after PCI.