冠心病经皮冠状动脉介入术后主要不良事件发生的影响因素分析

Influencing factors of main adverse cardiac events after percutaneous coronary intervention

目的探讨冠心病经皮冠状动脉介入术(PCI)后主要不良心血管事件(MACE)发生的影响因素。方法回顾性分析2021年5月至2022年5月上海交通大学医学院附属新华医院心血管内科择期进行冠心病PCI患者108例的临床资料。PCI术后24 h进行高压氧(HBO)辅助治疗,并随访6个月,根据患者是否发生MACE,将患者分为MACE组(n=36)和无MACE组(n=72)。采用全自动生化分析仪检测患者清晨空腹静脉血血脂水平;采用酶联免疫吸附法检测患者血清高敏C反应蛋白、肿瘤坏死因子-α、γ干扰素、白细胞介素-10、心肌营养素-1(CT-1)、血管细胞间黏附分子1(VCAM1)水平。分别于治疗前后应用彩色多普勒超声诊断仪测定颈动脉斑块面积和颈动脉内膜中层厚度。结果与治疗前比较,2组患者治疗后总胆固醇、三酰甘油、低密度脂蛋白胆固醇、CT-1、高敏C反应蛋白、肿瘤坏死因子-α、白细胞介素-10、γ干扰素水平及颈动脉斑块面积、颈动脉内膜中层厚度均明显减少或降低,高密度脂蛋白胆固醇和VCAM1水平明显升高(P<0.01)。治疗后MACE组总胆固醇、三酰甘油、低密度脂蛋白胆固醇、CT-1、高敏C反应蛋白、肿瘤坏死因子-α、白细胞介素-10、γ干扰素及颈动脉斑块面积、颈动脉内膜中层厚度明显低于无MACE组,高密度脂蛋白胆固醇、VCAM1水平明显高于无MACE组(P<0.01)。结论冠心病PCI术后辅助HBO治疗,通过调节血清CT-1、VCAM1水平,减轻患者机体炎症反应,降低血脂水平,减少颈动脉斑块面积,降低颈动脉内膜中层厚度,从而减少PCI术后MACE的发生。

Objective To explore the influencing factors of main adverse cardiac events(MACE)after percutaneous coronary intervention(PCI)in patients with coronary heart disease.Methods The clinical data of 108 patients with coronary heart disease undergoing elective PCI in the Department of Cardiovascular Medicine of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from May 2021 to May 2022 were retrospectively analyzed.Hyperbaric oxygen(HBO)therapy was performed on 24 h after PCI,and the patients had been followed up for 6 months.According to the occurrence of MACE,the patients were divided into MACE group(n=36)and non-MACE group(n=72).Automatic biochemical analyzer was used to detect the level of fasting venous blood lipid,and Enzyme-Linked Immunosorbent Assay was conducted to detect the levels of serum high-sensitive C-reactive protein,tumor necrosis factor-α,interferon gamma,interleukin-10,cardiotrophin-1(CT-1),and vascular cell adhesion molecule 1(VCAM1).Color Doppler ultrasonography was applied to measure carotid plaque area and carotid intima-media thickness before and after treatment,respectively.Results After treatment,levels of total cholesterol,triglyceride,low-density lipoprotein cholesterol,CT-1,high-sensitive C-reactive protein,tumor necrosis factor-α,interleukin-10,and interferon gamma in the two groups were significantly decreased;carotid plaque area and carotid intima-media thickness in the two groups were significantly reduced;levels of high-density lipoprotein cholesterol and VCAM1 in the two groups were significantly increased(P<0.01).The levels of total cholesterol,triglyceride,low-density lipoprotein cholesterol,CT-1,high-sensitive C-reactive protein,tumor necrosis factor-α,interleukin-10,and interferon gamma in the MACE group were significantly lower than those in the non-MACE group,and carotid plaque area and carotid intima-media thickness in the MACE group were significantly smaller than those in the non-MACE group,but the levels of high-density lipoprotein cholesterol and VCAM1 in the MACE group were significantly higher than those in the non-MACE group.Conclusion HBO therapy after PCI can reduce inflammatory response,blood lipid level,carotid plaque area,and carotid intima-media thickness by regulating the levels of serum CT-1 and VCAM1,thus providing a valuable evidence for the prevention and treatment of MACE after PCI.