血清cTnI、hs-CRP、HCY及相关临床特征与冠心病PCI治疗后支架内再狭窄间的相关性分析

Correlation analysis of serum cTnI,hs-CRP,HCY and related clinical characteristics with in-stent restenosis after PCI in patients with coronary heart disease

目的探讨血清肌钙蛋白I(cTnI)、超敏C反应蛋白(hs-CRP)、同型半胱氨酸(HCY)及相关临床特征与冠心病经皮冠状动脉介入(PCI)治疗后支架内再狭窄(ISR)间的相关性。方法回顾性分析2020年2月至2022年2月太原钢铁(集团)有限公司总医院收治的行PCI术治疗的98例冠心病患者临床资料,并依据ISR发生情况分为ISR组(n=15)和非ISR组(n=83)。收集两组基本资料,包括年龄、性别、体重指数、高血压病史、糖尿病病史、既往史、冠状脉狭窄支数、病变长度、病变支架长度、侵犯血管类型、收缩压和相关实验室指标[高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇、甘油三酯、肌酸激酶同工酶(CK-MB)、白细胞介素-6(IL-6)、超敏C反应蛋白(hs-CRP)、肌钙蛋白I(cTnI)、同型半胱氨酸(HCY)]。再经过多因素Logistic回归分析,明确冠心病患者PCI术后ISR的危险因素。结果两组年龄、性别构成比、体重指数、高血压病史、既往史、冠状脉狭窄支数、病变长度、侵犯血管类型占比及HDL-C、LDL-C、总胆固醇、甘油三酯、CK-MB、IL-6、收缩压水平比较,差异均无统计学意义(P>0.05);ISR组有糖尿病病史占比、病变支架长度及血清hs-CRP、cTnI、HCY水平均高于非ISR组,差异均有统计学意义(P<0.05)。受试者工作特征(ROC)曲线分析显示,病变支架长度及血清cTnI、hs-CRP、HCY均能预测冠心病患者PCI术后ISR的发生,曲线下面积分别为0.861、0.801、0.812、0.764,预测价值较好(P<0.05)。多因素Logistic回归分析结果显示,有糖尿病病史、病变支架长度≥32.825 mm、cTnI≥9.295μg/L、hs-CRP≥39.400 g/L、HCY≥11.650μmol/L为冠心病患者PCI术后ISR的危险因素(P<0.05)。结论冠心病患者PCI术后ISR的发生受糖尿病病史、病变支架长度及血清cTnI、hs-CRP、HCY水平影响,并对PCI术后ISR的发生具有较好的预测价值。

Objective To investigate the correlation between serum troponin I(cTnI),hypersensitive C-reactive protein(hs-CRP),homocysteine(HCY)and related clinical features and in-stent restenosis(ISR)after percutaneous coronary intervention(PCI).Methods The clinical data of 98 patients with coronary heart disease who underwent PCI in General Hospital of Taiyuan Iron and Steel Group Co.from February 2020 to February 22 were retrospectively analyzed,and they were divided into ISR group(n=15)and non-ISR group(n=83)according to the occurrence of ISR.The basic data of two groups were collected,including age,gender,body mass index,hypertension history,diabetes history,past history,number of coronary stenoses,lesion length,type of involved vessels systolic blood pressure and related laboratory indicators[high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),total cholesterol,triacylglycerol,creatine kinase isoenzyme(CK-MB),interleukin-6(IL-6),hs-CRP,cTnI,HCY].The risk factors of ISR in patients with coronary heart disease after PCI were determined by multivariate Logistic regression analysis.Results There was no statistically significant differences between the two groups in age,sex,body mass index,history of hypertension,past history,number of coronary artery stenosis,length of lesion,proportion of vascular invasion type,and levels of HDL-C,LDL-C,total cholesterol,triacylglycerol,CK-MB,IL-6 and systolic blood pressure(P>0.05);the percentage of patients with diabetes history,the length of diseased stent,and the levels of hs-CRP,cTnI,HCY in serum in ISR group were higher than those in non ISR group,and the differences were statistically significant(P<0.05).The receiver operating characteristic(ROC)curve analysis showed that the length of the diseased stent and the serum cTnI,hs-CRP and HCY could predict the occurrence of ISR in patients with coronary heart disease after PCI,and the area under the curve was 0.861,0.801,0.812 and 0.764,respectively,had good predictive value(P<0.05).Multivariate Logistic regression analysis showed that there was a history of diabetes,the length of diseased stent≥32.825 mm,cTnI≥9.295μg/L,hs-CRP≥39.400 g/L,HCY≥11.650μmol/L was the risk factor of ISR in patients with coronary heart disease after PCI(P<0.05).Conclusion The occurrence of ISR in patients with coronary heart disease after PCI is affected by the history of diabetes,the length of the diseased stent,and the levels of cTnI,hs-CRP,HCY in serum,and has a good predictive value for the occurrence of ISR after PCI.