SAA、VCAM-1与冠心病患者PCI术后氯吡格雷抵抗的关系及对预后的预测价值

Relationship between SAA,VCAM-1 and clopidogrel resistance in patients with coronary heart disease after PCI and its predictive value for prognosis

目的分析淀粉样蛋白酶A(SAA)、血管细胞黏附分子-1(VCAM-1)与冠心病患者经皮冠状动脉介入(PCI)术后氯吡格雷抵抗的关系及其对预后的预测价值。方法纳入2020年5月至2022年5月西安医学院第一附属医院心内科行PCI治疗的130例冠心病患者,检测术后36 h血清SAA、VCAM-1水平及血小板抑制率,依据血小板抑制率将其分为抵抗组(n=28)和非抵抗组(n=102)。比较两组患者的一般资料及血清SAA、VCAM-1水平,采用Logistic回归分析氯吡格雷抵抗的独立相关因素,根据术后6个月不良心血管事件发生情况分为预后良好组105例和预后不良组25例,比较两组患者的血清SAA、VCAM-1水平,采用受试者工作特征曲线(ROC)评估血清SAA、VCAM-1对患者不良预后的预测价值。结果抵抗组与非抵抗组患者的一般资料比较差异均无统计学意义(P>0.05);抵抗组患者的血清SAA、VCAM-1水平分别为(13.48±4.21)mg/L、(1277.13±216.46)ng/mL,明显高于非抵抗组的(9.74±2.81)mg/L、(1016.34±145.72)ng/mL,差异均具有统计学意义(P<0.05);经Logistic回归分析结果显示,SAA、VCAM-1均为冠心病患者PCI术后氯吡格雷抵抗的独立相关因素(P<0.05);预后不良组患者的血清SAA、VCAM-1水平分别为(14.19±3.92)mg/L、(1392.76±185.23)ng/mL,明显高于预后良好组的(9.67±2.87)mg/L、(1002.39±139.87)ng/mL,差异均有统计学意义(P<0.05);经ROC分析结果显示,血清SAA、VCAM-1单独及联合预测PCI术后不良心血管事件的曲线下面积(AUC)分别为0.774、0.805、0.937。结论SAA、VCAM-1是冠心病PCI术后氯吡格雷抵抗的独立相关因素,联合检测对术后不良心血管事件具有一定的预测价值。

Objective To analyze the relationship between serum amyloid A(SAA),vascular cell adhesion molecule-1(VCAM-1)and clopidogrel resistance in patients with coronary heart disease after percutaneous coronary intervention(PCI)and its predictive value for prognosis.Methods A total of 130 patients with coronary heart disease who underwent PCI in the Department of Cardiology,First Affiliated Hospital of Xi'an Medical College from May 2020 to May 2022 were enrolled.Serum SAA,VCAM-1 levels and platelet inhibition rate were measured 36 hours after operation.According to platelet inhibition rate,they were divided into resistance group(n=28)and non-resistance group(n=102).The general data and serum SAA and VCAM-1 levels were compared between the two groups.Logistic regression was used to analyze the independent related factors of clopidogrel resistance.According to the occurrence of adverse cardiovascular events at 6 months after operation,the patients were divided into good prognosis group(105 cases)and poor prognosis group(25 cases).The serum SAA and VCAM-1 levels were compared between the two groups.The receiver operating characteristic curve(ROC)was used to evaluate the predictive value of serum SAA and VCAM-1 on the poor prognosis of patients.Results There were no statistically significant differences in general data between the two groups(P>0.05).The serum SAA and VCAM-1 levels in the resistance group were(13.48±4.21)mg/L and(1277.13±216.46)ng/mL,respectively,which were significantly higher than(9.74±2.81)mg/L and(1016.34±145.72)ng/mL in the non-resistance group(P<0.05).Logistic regression analysis showed that SAA and VCAM-1 were independent related factors of clopidogrel resistance in patients with coronary heart disease after PCI(P<0.05).The serum SAA and VCAM-1 levels in the poor prognosis group were(14.19±3.92)mg/L and(1392.76±185.23)ng/mL,respectively,which were significantly higher than(9.67±2.87)mg/L and(1002.39±139.87)ng/mL in the good prognosis group(P<0.05).The results of ROC analysis showed that the area under the ROC curve(AUC)of serum SAA,VCAM-1 alone and in combination in predicting adverse cardiovascular events after PCI was 0.774,0.805,and 0.937,respectively.Conclusion SAA and VCAM-1 are independent related factors of clopidogrel resistance after PCI in coronary heart disease.Combined detection has certain predictive value for postoperative adverse cardiovascular events.