冠心宁片对颈动脉支架植入术后患者脂质代谢因子及再狭窄发生情况的影响

Effects of Guanxinning tablets on lipid metabolism factors and restenosis in patients after carotid artery stenting

目的探究颈动脉支架植入术(CAS)后再狭窄的影响因素及冠心宁片的治疗作用。方法回顾性分析2018年1月至2022年1月在浙江省丽水市第二人民医院住院的159例颈动脉重度狭窄患者资料,依据随访结果分为未狭窄组和再狭窄组。采用单因素分析及多因素Logistic回归分析探究血脂指标[总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、氧化低密度脂蛋白(ox-LDL)]、纤维蛋白原(FIB)、胱抑素C(CysC)、脂质代谢因子[脂肪酸合成酶(FASN)、硬脂酰辅酶A去饱和酶1(SCD1)、胆固醇调节元件结合蛋白-1(SREBP-1)、胆固醇调节元件结合蛋白-2(SREBP-2)]和炎症因子[白细胞介素(IL)-6、IL-1β、肿瘤坏死因子α(TNF-α)]水平对患者CAS术后再狭窄的影响。采用转录组测序探究2组差异基因谱和富集通路。并选取2022年3月至2023年3月住院的颈动脉重度狭窄患者80例,按随机数字表法分为观察组和对照组,各40例。对照组术后给予常规治疗,观察组加用冠心宁片治疗,于治疗前后检测上述指标,统计术后半年内再狭窄发生率。结果再狭窄组患者IL-1β、IL-6、TNF-α、FIB、TG、TC、LDL-C、ox-LDL、FASN、SREBP-1、SREBP-2水平高于未狭窄组患者(P<0.05),CysC高于未狭窄组患者(P<0.05)。转录组测序结果显示2组差异基因富集通路主要为脂质代谢、脂肪酸合成和炎症级联反应。多因素Logistic回归分析显示,ox-LDL、FIB、IL-6、TNF-α、SREBP-1、SREBP-2和FASN是CAS术后再狭窄的独立影响因素(P<0.05)。治疗后,观察组TNF-α、FIB、TG、TC、LDL-C、ox-LDL、FASN、SREBP-1和SREBP-2水平低于对照组(P<0.05)。对照组术后再狭窄发生率为12.5%,观察组再狭窄发生率为5.0%。结论炎症因子IL-6、TNF-α、FIB和脂质代谢因子ox-LDL、SREBP-1、SREBP-2、FASN是CAS术后再狭窄的独立影响因素,冠心宁片治疗可进一步改善患者炎症和血脂水平。

Objective To explore the effects of Guanxinning tablets on lipid metabolism factors and restenosis in patients after carotid artery stenting(CAS).Methods A retrospective analysis was conducted on the data of 159 patients with severe carotid artery stenosis admitted to Lishui Second People′s Hospital from January 2018 to January 2022.Based on the follow-up results,they were divided into the non-stenosis group and the restenosis group.Single-factor analysis and multivariate Logistic regression analysis were used to explore the ef-fects of blood lipid indicators[total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),triglyceride(TG),oxidized low-density lipoprotein(ox-LDL)],fibrinogen(FIB),cys-tatin C(CysC),lipid metabolism factors[fatty acid synthase(FASN),stearoyl-CoA desaturase 1(SCD1),sterol reg-ulatory element-binding protein-1(SREBP-1),and sterol regulatory element-binding protein-2(SREBP-2)],and in-flammatory factors[interleukin-6(IL-6),IL-1β,tumor necrosis factor-α(TNF-α)]on restenosis after carotid artery stenting(CAS).Transcriptome sequencing was used to explore the differential gene profiles and enriched pathways between the two groups.A total of 80 patients with severe carotid stenosis who were hospitalized from March 2022 to March 2023 were selected and randomly divided into an observation group and a control group,with 40 patients in each group.The control group received conventional treatment after surgery,while the observation group re-ceived additional Guanxinning tablet treatment.The above-mentioned indicators were measured before and after treatment,and the incidence of restenosis within half a year after surgery was recorded and compared for both groups.Results The levels of IL-1β,IL-6,TNF-α,FIB,TG,TC,LDL-C,ox-LDL,FASN,SREBP-1,and SREBP-2 in the restenosis group were significantly higher than those in the non-stenosis group(P<0.05),and the CysC level was also significantly higher in the restenosis group than in the non-stenosis group(P<0.05).The results of transcriptome sequencing showed that the enriched pathways of differentially expressed genes between the two groups were mainly lipid metabolism,fatty acid synthesis,and inflammatory cascades.Multivariate Logistic regres-sion analysis showed that ox-LDL,FIB,IL-6,TNF-α,SREBP-1,SREBP-2,and FASN were independent factors in-fluencing restenosis after carotid artery stenting(CAS)(P<0.05).After treatment,the levels of TNF-α,FIB,TG,TC,LDL-C,ox-LDL,FASN,SREBP-1,and SREBP-2 in the observation group were significantly lower than those in the control group(P<0.05).The restenosis rates after surgery in the control group and observation group were 12.5%and 5.0%,respectively.Conclusion Inflammatory factors such as IL-6,TNF-α,and FIB,as well as lipid metabolism factors including ox-LDL,SREBP-1,SREBP-2,and FASN are independent influencing factors for restenosis after CAS.Guanxinning tablets treatment can further improve patients′inflammatory and lipid levels.