血清胱抑素C、血管性血友病因子裂解酶与冠心病患者经皮冠状动脉介入治疗后无复流的相关性

Correlation Between Serum Cystatin C,Von Willebrand Factor Cleaving Protease and no Reflow After Percutaneous Coronary Intervention in Patients with Coronary Heart Disease

目的探讨血清胱抑素C(Cys-C)、血管性血友病因子裂解酶(ADAMTS-13)与冠心病患者经皮冠状动脉介入(PCI)治疗后无复流的相关性。方法选取2019年1月至2020年12月义马煤业集团股份有限公司总医院收治的142例冠心病患者,所有患者均接受PCI治疗,术后采用心肌梗死溶栓治疗(TIMI)血流分级评估所有患者无复流情况,根据结果分为无复流组(TIMI分级0~Ⅱ级)、复流组(TIMI分级Ⅲ级),统计两组患者的临床资料,分析血清ADAMTS-13、Cys-C与冠心病患者介入治疗后无复流的关系。结果142例冠心病患者介入治疗后无复流20例,占14.08%(20/142);无复流组血清Cys-C、超敏C反应蛋白(hs-CRP)水平高于复流组,血清ADAMTS-13水平低于复流组(P<0.05);回归分析结果显示,入院时血清Cys-C、hs-CRP过表达是冠心病患者介入治疗后无复流的危险因子(OR>1,P<0.05),血清ADAMTS-13过表达是冠心病患者介入治疗后无复流的保护因子(OR<1,P<0.05);绘制受试者工作特征(ROC)曲线,结果显示,入院时血清Cys-C、ADAMTS-13预测冠心病患者介入治疗无复流风险的曲线下面积(AUC)均>0.70,预测价值较理想。结论冠心病患者介入治疗后无复流与入院时血清ADAMTS-13、Cys-C水平有关,血清Cys-C过表达、ADAMTS-13低表达者介入治疗后无复流的发生风险高。

Objective To investigate the correlation between serum Cystatin C(Cys-C),von Willebrand factor cleaving protease(ADAMTS-13)and no reflow after percutaneous coronary intervention(PCI)therapy in patients with coronary heart disease.Methods A total of 142 patients with coronary heart disease treated in Yima Coal Industry Group Company Limited General Hospital from January 2019 to December 2020 were selected.All patients received PCI.After the operation,the blood flow grade of thrombolysis in myocardial infarction(TIMI)was used to evaluate the no reflow condition of all patients.According to the results,they were divided into no reflow group(TIMI grade 0-Ⅱ)and reflow group(TIMI gradeⅢ).The clinical data of patients in the two groups were counted,the relationship between serum ADAMTS-13,Cys-C and no reflow after interventional therapy in patients with coronary heart disease was analyzed.Results Among 142 patients with coronary heart disease,20 cases had no reflow after interventional therapy,accounting for 14.08%(20/142).The levels of serum Cys-C and hypersensitive C-reactive protein(hs-CRP)in no reflow group were higher than those in reflow group,and the level of serum ADAMTS-13 was lower than that in reflow group(P<0.05).The results of regression analysis showed that,the overexpression of serum Cys-C and hs-CRP at admission was risk factors for no reflow after interventional therapy in patients with coronary heart disease(OR>1,P<0.05),and serum ADAMTS-13 overexpression was a protective factor for no reflow after interventional therapy in patients with coronary heart disease(OR<1,P<0.05).The receiver operating characteristic(ROC)curve was drawn,and the results showed that,the area under the curve(AUC)of serum Cys-C and ADAMTS-13 at admission in predicting the risk of no reflow in patients with coronary heart disease after interventional therapy were>0.70,including indeal predictive value.Conclusion No reflow after interventional therapy in patients with coronary heart disease is related to the levels of serum ADAMTS-13 and Cys-C at admission,those with overexpression of serum Cys-C and low expression of ADAMTS-13 have a high risk of no reflow after interventional therapy,which is valuable to predict no reflow.