血清分拣蛋白联合细胞外基质金属蛋白酶诱导因子对颈动脉支架置入术后支架内再狭窄的预测价值

The predictive value of serum sorting protein combined with extracellular matrix metalloproteinase inducer for in stent restenosis after carotid stent placement surgery

目的探讨血清分拣蛋白(Sortilin)联合细胞外基质金属蛋白酶诱导因子(EMMPRIN)对颈动脉支架置入术(CAS)后支架内再狭窄(ISR)的预测价值。方法选择2018年1月至2020年10月在首都医科大学大兴教学医院进行CAS治疗的197例颈动脉狭窄患者作为研究对象。所有患者术后随访24个月,根据是否发生ISR分为ISR组(28例)和非ISR组(169例)。酶联免疫吸附法(ELISA)检测并比较两组术前血清Sortilin、EMMPRIN水平。收集患者的临床资料,单因素及多因素logistic回归模型分析CAS术后ISR的影响因素。受试者工作特征(ROC)曲线分析血清Sortilin、EMMPRIN对CAS术后ISR的预测价值。结果ISR组血清Sortilin、EMMPRIN及年龄、合并高血压占比、术前狭窄程度、中性粒细胞计数(NEUT)、血小板计数(PLT)、白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)、甘油三酯(TG)、总胆固醇(TC)高于非ISR组(均P<0.05)。多因素logistic回归分析结果显示,PLT、WBC及血清Sortilin、EMMPRIN升高是CAS术后发生ISR的独立危险因素(均P<0.05)。ROC曲线分析显示,血清Sortilin、EMMPRIN单独及两项联合预测CAS术后ISR的ROC曲线下面积(AUC)分别为0.735(95%CI:0.546~0.918)、0.766(95%CI:0.615~0.910)、0.839(95%CI:0.701~0.984),联合应用的预测效能大于两者指标单独预测。结论CAS术后发生ISR的患者术前血清Sortilin、EMMPRIN水平异常升高,是CAS术后发生ISR的独立危险因素,联合检测血清Sortilin、EMMPRIN对CAS术后ISR的发生风险具有较好的预测价值。

Objective To explore the predictive value of serum sorting protein(Sortilin)combined with extracellular matrix metalloproteinase inducible factor(EMMPRIN)for in stent restenosis(ISR)after carotid artery stent placement(CAS).Methods A total of 197 patients with carotid artery stenosis who underwent CAS treatment at the Capital Medical University Daxing Teaching Hospital from January 2018 to October 2020 were selected as the study subjects.All patients were followed up for 24 months after surgery and were divided into an ISR group(28 cases)and a non ISR group(169 cases)based on the occurrence of ISR.Enzyme linked immunosorbent assay(ELISA)was used to detect and compare the preoperative serum Sortilin and EMMPRIN levels between the two groups.We collected clinical data from patients and analyzed the influencing factors of post CAS ISR using univariate and multivariate logistic regression models.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum Sortilin and EMMPRIN for postoperative ISR in CAS.Results The serum Sortilin,EMMPRIN,age,proportion of concomitant hypertension,degree of preoperative stenosis,neutrophil count(NEUT),platelet count(PLT),white blood cell count(WBC),high-sensitivity C-reactive protein(hs-CRP),triglycerides(TG),and total cholesterol(TC)in the ISR group were higher than those in the non ISR group(all P<0.05).The results of multivariate logistic regression analysis showed that PLT,WBC,and elevated serum Sortilin and EMMPRIN were independent risk factors for the occurrence of ISR after CAS surgery(all P<0.05).ROC curve analysis showed that the AUC under the ROC curve of serum Sortilin and EMMPRIN alone and in combination for predicting postoperative ISR in CAS were 0.735(95%CI:0.546-0.918),0.766(95%CI:0.615-0.910),and 0.839(95%CI:0.701-0.984),respectively.The predictive efficacy of the combined application was greater than that of the two indicators alone.Conclusions Patients with postoperative ISR after CAS have abnormally elevated levels of serum Sortilin and EMMPRIN before surgery,which are independent risk factors for postoperative ISR.The combined detection of serum Sortilin and EMMPRIN has good predictive value for the risk of postoperative ISR in CAS.