血清CXCL10、CCCK-18水平对伴糖尿病冠心病患者PCI术后短期预后的预测效能

Predictive efficacy of serum CXC chemokine ligand 10 and caspase-cleaved cytokeratin-18 levels on the short-term prognosis of coronary heart disease patients with diabetes mellitus after percutaneous coronary intervention

目的探讨血清CXC趋化因子配体10(CXCL10)、细胞角蛋白18裂解片段(CCCK-18)水平对伴糖尿病冠心病患者经皮冠状动脉介入术(PCI)后短期预后的预测效能。方法选取2020年12月至2022年12月在安阳市第三人民医院实施相应PCI手术的149例伴糖尿病冠心病患者作为研究对象,采用酶联免疫吸附法检测血清CXCL10、CCCK-18水平。术后随访3个月,根据患者是否发生主要心血管不良事件(MACE)分为预后良好组121例和预后不良组28例。采用受试者工作特征曲线(ROC)评估血清CXCL10、CCCK-18水平对伴糖尿病冠心病患者PCI术后短期预后的预测效能,采用二分类Logistic逐步回归分析探讨伴糖尿病冠心病患者PCI术后短期预后的影响因素。结果预后不良组患者冠状动脉评分(Gensini)≥70分和多支血管病变的占比分别为78.57%、89.29%,明显高于预后良好组的43.80%、60.33%,差异均有统计学意义(P<0.05),其他临床资料比较差异均无统计学意义(P>0.05);预后不良组患者的血清CXCL10、CCCK-18水平分别为(19.35±2.41)ng/mL、(306.45±33.69)U/L,明显高于预后良好组的(8.63±1.87)ng/mL、(218.36±22.15)U/L,差异均有统计学意义(P<0.05);经ROC分析结果显示,血清CXCL10、CCCK-18水平预测伴糖尿病冠心病患者PCI术后短期预后的最佳截断值分别为13.51 ng/L、262.47 U/L,而两者联合预测的曲线下面积(AUC)95%置信区间(95%CI)为0.912(0.868~0.957);经多因素Logistic逐步回归分析结果显示:Gensini评分≥70分、多支血管病变、CXCL10、CCCK-18均是伴糖尿病冠心病患者PCI术后短期预后的影响因素(P<0.05)。结论伴T2DM冠心病PCI术后预后不良患者的血清CXCL10、CCCK-18水平较预后良好者明显升高,两者联合检测对术后不良心血管事件具有一定的预测效能。

Objective To explore the predictive effect of serum CXC chemokine ligand 10(CXCL10)and caspase-cleaved cytokeratin-18(CCCK-18)levels on the short-term prognosis of coronary heart disease patients with diabetes after percutaneous coronary intervention(PCI).Methods A total of 149 coronary heart disease patients with diabetes mellitus who underwent PCI in Anyang Third People's Hospital from December 2020 to December 2022 were selected as the study objects.Serum CXCL10 and CCCK-18 levels were detected by enzyme-linked immunosorbent assay.After 3 months of postoperative follow-up,the patients were divided into a good prognosis group(121 cases)and a poor prognosis group(28 cases)based on whether they had major adverse cardiovascular events(MACE).The predictive efficacy of serum CXCL10 and CCCK-18 levels on the short-term prognosis of coronary heart disease patients with diabetes after PCI was evaluated using the receiver operating characteristic(ROC)curve.The factors influencing the short-term prognosis of coronary heart disease patients with diabetes after PCI were analyzed using binary logistic stepwise regression analysis.Results The proportion of patients with a coronary artery score(Gensini)≥70 and those with multiple vessel lesions were 78.57%and 89.29%in the poor prognosis group,respectively,which were significantly higher than 43.80%and 60.33%in the good prognosis group(P<0.05).There was no statistically significant difference in other clinical data(P>0.05).The serum levels of CXCL10 and CCCK-18 in the poor prognosis group were(19.35±2.41)ng/mL and(306.45±33.69)U/L,respectively,which were significantly higher than(8.63±1.87)ng/mL and(218.36±22.15)U/L in the good prognosis group(P<0.05).ROC analysis results showed that the best cutoff values of serum CXCL10 and CCCK-18 levels for predicting the short-term prognosis of coronary heart disease patients with diabetes after PCI were 13.51 ng/L and 262.47 U/L,respectively,while the area under the ROC curve(AUC)(95%CI)predicted by CXCL10 combined with CCCK-18 was 0.912(0.868-0.957).Multivariate logistic stepwise regression analysis showed that Gensini score≥70,multi vessel lesions,CXCL10,CCCK-18 were all factors influencing the short-term prognosis of coronary heart disease patients with diabetes after PCI(P<0.05).Conclusion The serum CXCL10 and CCCK-18 levels in the patients with poor prognosis after PCI were significantly higher than those in patients with good prognosis.The combined detection of CXCL10 and CCCK-18 has a certain predictive effect on adverse cardiovascular events after PCI.