急性冠状动脉综合征行PCI术患者血清sTREM-1、S100A12、FGF-23水平及其预测术后支架内再狭窄的价值

Expression of serum STREM-1,S100A12 and FGF-23 in patients with acute coronary syndrome undergoing PCI and their value in predicting postoperative in-stent restenosis

目的探究急性冠状动脉综合征(ACS)行经皮冠状动脉介入治疗(PCI)术患者血清可溶性髓系细胞触发受体1(sTREM-1)、S100钙结合蛋白A12(S100A12)、成纤维细胞生长因子23(FGF-23)水平及其预测术后支架内再狭窄(ISR)的价值。方法选取2020年1月至2021年2月青岛阜外心血管病医院收治的156例ACS且行PCI术患者纳入研究组,另选取同期健康人群90例纳入对照组。Pearson分析血清sTREM-1、S100A12、FGF-23和炎症因子的相关性。研究组随访1年,根据患者是否发生ISR分为再狭窄组和无再狭窄组;对比再狭窄组和无再狭窄组血清sTREM-1、S100A12、FGF-23水平;单因素和多因素Logistic分析ACS患者PCI术后发生ISR的危险因素;采用受试者工作特征(ROC)曲线分析sTREM-1、S100A12、FGF-23水平对术后发生ISR的预测价值。结果研究组sTREM-1、S100A12、FGF-23和血清白细胞介素(IL)-6、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平均明显高于对照组(均P<0.05);血清sTREM-1、S100A12和FGF-23与血清IL-6、TNF-α、CRP之间均呈正相关(均P<0.05);Logistic回归模型分析结果显示sTREM-1、S100A12、FGF-23、IL-6、TNF-α、CRP、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)和下肢完全闭塞是ACS患者PCI术后发生ISR的危险因素(P<0.05);sTREM-1、S100A12联合FGF-23预测ACS患者PCI术后发生ISR的ROC曲线下面积(AUC)为0.882(95%CI:0.817~0.930),具有较高的特异度及灵敏度。结论ACS行PCI术患者血清sTREM-1、S100A12、FGF-23水平呈异常高表达,sTREM-1、S100A12、FGF-23、IL-6、TNF-α、CRP、CK-MB、LDH和下肢完全闭塞是影响ACS患者PCI术后发生ISR的危险因素,sTREM-1、S100A12、FGF-23联合检测对ACS患者PCI术后发生ISR具有较高的预测效能。

Objective To investigate the expression of soluble triggering receptor expressed on myeloid cells-1(STREM-1),S100 calcium-binding proteinA12(S100A12)and fibroblast growth factor 23(FGF23)in serum of patients with acute coronary syndrome(ACS)undergoing percutaneous coronary intervention(PCI)and their value in predicting postoperative in-stent restenosis(ISR).Methods A total of 156 ACS patients who underwent PCI in Qingdao Fuwai Cardiovascular Hospital from January 2020 to February 2021 were enrolled in the study group,and 90 healthy people during the same period were enrolled in the control group.Pearson method was used to analyze the correlation between serum sTREM-1,S100A12,FGF-23 and inflammatory factors.The study group was followed up for one year,patients were divided into restenosis group and non-restenosis group according to whether ISR occurred.The serum levels of sTREM-1,S100A12 and FGF-23 were compared between the restenosis group and non-restenosis group.Univariate and multivariate Logistic analysis were used to analyze the risk factors of ISR in ACS patients after PCI.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of sTREM-1,S100A12 and FGF-23 levels on the occurrence of ISR after operation.Results The levels of sTREM-1,S100A12,FGF-23 and serum interleukin(IL)-6,tumor necrosis factor(TNF)-αand C-reactive protein(CRP)in the study group were significantly higher than those in the control group(all P<0.05).Serum levels of sTREM-1,S100A12 and FGF-23 were positively correlated with serum levels of IL-6,TNF-αand CRP(all P<0.05).Logistic regression model analysis showed that sTREM-1,S100A12,FGF-23,IL-6,TNF-α,CRP,CK-MB,LDH and total occlusion of lower extremity were risk factors for ISR in ACS patients after PCI(P<0.05).The area under curve(AUC)of sTREM-1,S100A12 combined with FGF-23 in predicting ISR in ACS patients after PCI was 0.882(95%CI:0.817-0.930),which had high specificity and sensitivity.Conclusion The serum levels of sTREM-1,S100A12 and FGF-23 are abnormally high in ACS patients undergoing PCI.sTREM-1,S100A12,FGF-23,IL-6,TNF-α,CRP,CK-MB,LDH and total occlusion of lower extremity are the main risk factors for the occurrence of ISR after operation.The combined detection of sTREM-1,S100A12 and FGF-23 has a high predictive efficiency for the occurrence of ISR after operation.