Lp-PLA2、PTX3对冠心病患者PCI术后支架内再狭窄的预测价值

Predictive value of Lp-PLA2 and PTX3 for ISR after PCI in CHD patients

目的探讨脂蛋白相关性磷脂酶A2(Lp-PLA2)、正五聚蛋白-3(PTX3)对冠状动脉粥样硬化性心脏病(CHD)患者经皮冠状动脉介入(PCI)术后支架内再狭窄(ISR)的预测价值。方法选取因冠状动脉严重狭窄行PCI治疗的CHD患者379例。根据术后6个月复查是否发生ISR,分为ISR组(n=53)、非ISR组(n=326)。收集两组一般临床资料,监测两组术后1 d的Lp-PLA2和PTX3水平。采用Logistic逐步回归分析ISR发生的危险因素。术后6个月复查外弹力膜横截面积(EEM-CSA)、斑块面积(PLA)、最小管腔面积(MLA),内膜面积(IPA)及Gensini积分。分析Lp-PLA2和PTX3与Gensini积分、EEM-CSA、MLA、PLA、IPA的相关性。采用ROC曲线评估Lp-PLA2和PTX3预测ISR的最佳截断值与AUC。结果①ISR组STEMI(P<0.05)、吸烟史(P<0.01)、糖尿病(P<0.01)、LDL-C(P<0.05)、支架串联(P<0.05)、应用分叉术式(P<0.01)、支架置入时长(P<0.01)、Lp-PLA2(P<0.05)、PTX3(P<0.01)高于非ISR组,HDL-C、LVEF、用药依从性低于非ISR组(均P<0.05)。吸烟(P<0.01)、LDL-C(P<0.01)、应用分叉术式(P<0.01)、糖尿病(P<0.01)、药物服用依从性(P<0.01)、Lp-PLA2(P<0.05)、PTX3(P<0.05)为ISR发生的独立危险因素。②ISR组Gensini积分高于非ISR组(P<0.01),与非ISR组相比,ISP组有更大的IPA、PLA(均P<0.05)及更小的EEM-CSA、MLA(均P<0.01)。Lp-PLA2、PTX3与Gensini积分、IPA、PLA呈正相关(均P<0.01),与EEM-CSA(均P<0.05)、MLA呈负相关(均P<0.01)。③Lp-PLA2、PTX3预测ISR的最佳截断值分别为310.65 ng/mL和3.87 ng/mL,AUC分别为0.780(95%CI:0.739~0.861)、0.751(95%CI:0.722~0.897),Lp-PLA2联合PTX3预测ISR的AUC为0.832(95%CI:0.817~0.933),明显高于Lp-PLA2、PTX3单独预测(Z=3.083,P=0.021;Z=3.697,P=0.017)。结论ISR患者PCI术后有较高水平的Lp-PLA2、PTX3,术后Lp-PLA2、PTX3水平监测有助于ISR发生风险预测,联合检测可提升ISR的预测价值。

AIM To investigate the predictive value of lipoprotein-associated phospholipase A2(Lp-PLA2)and pentraxin 3(PTX3)for in-stent restenosis(ISR)after percutaneous coronary intervention(PCI)in patients with coronary atherosclerotic heart disease(CHD).METHODS A total of 379 CHD patients undergoing PCI for severe coronary artery stenosis were selected.According to the reexamination of ISR 6 months after the operation,53 cases were divided into ISR group and 326 cases were non-ISR group.General clinical data of patients in both groups were collected.Lp-PLA2 and PTX3 levels in both groups were monitored 1d after surgery.Logistic stepwise regression was used to analyze the risk factors of ISR.The cross-sectional area of the elastic membrane(EEM-CSA),plaque area(PLA),minimum lumen area(MLA),intima proliferation area(IPA)and Gensini score were reviewed 6 months after the operation.The correlation of Lp-PLA2 and PTX3 with Gensini score,EEM-CSA,MLA,PLA,IPA was analyzed.The optimum cut-off value and AUC of Lp-PLA2 and PTX3 for predicting ISR were evaluated by ROC curve.RESULTS(1)STEMI(P<0.05),smoking history(P<0.01),diabetes(P<0.01),LDL-C(P<0.05),stent tandem(P<0.05),bifurcation operation(P<0.01),stent placement duration(P<0.01),LP-PLA2(P<0.05)and PTX3(P<0.01)were higher in ISR group than in non-ISR group,HDL-C,LVEF and medication compliance were lower in ISR group than in non-ISR group(ALL P<0.05).Smoking(P<0.01),LDL-C(P<0.01),bifurcation procedure(P<0.01),diabetes(P<0.01),medication compliance(P<0.01),LP-PLA2(P<0.05)and PTX3(P<0.05)were independent risk factors for ISR.(2)The Gensini score of ISR group was higher than that of non-ISR group(P<0.01).Compared with the non-ISR group,the ISR group had larger IPA,PLA(all P<0.05)and smaller EM-CSA and MLA(all P<0.01).Lp-PLA2 and PTX3 were positively correlated with Gensini score,IPA and PLA(all P<0.01),but negatively correlated with EEM-CSA(all P<0.05)and MLA(all P<0.01).(3)The optimal truncation values of Lp-PLA2 and PTX3 for predicting ISR were 310.65 ng/mL and 3.87 ng/mL,respectively,and AUC were 0.780(95%CI:0.739-0.861)and 0.751(95%CI:0.751),respectively.The AUC of ISR predicted by LP-PLA2 combined with PTX3 was 0.832(95%CI:0.817-0.933),which was significantly higher than that predicted by LP-PLA2 and PTX3 alone(Z=3.083,P=0.021;Z=3.697,P=0.017).CONCLUSION ISR patients have higher lP-PLA2 and PTX3 levels after PCI,and monitoring of lP-PLA2 and PTX3 levels after PCI is helpful to predict the risk of ISR occurrence,the combined detection enhances the predictive value of ISR.