血管内皮生长因子、支架直径和支架长度对支架内再狭窄的联合预测价值

杨晓云; 郭靖涛; 刘长飞; 周江; 罗东雷

doi:10.12125/j.chj.202005024

血管内皮生长因子、支架直径和支架长度对支架内再狭窄的联合预测价值

Combined predictive value of vascular endothelial growth factor, stent diameter and stent length for in-stent restenosis

摘要

摘要:
目的探讨血管内皮生长因子（vascular endothelial growth factor，VEGF）、支架直径和支架长度对冠状动脉药物洗脱支架(drug-eluting stent, DES)置入术后支架内再狭窄（in-stent restenosis，ISR）患者的联合预测价值。
方法收集2014年6月至2016年8月在承德市中心医院心内科行DES置入的不稳定型心绞痛患者332（男178，女154）例。根据术后1年复查冠脉造影结果将其分为ISR组（n=41）和非ISR组（n=291），比较两组的一般临床资料及冠脉支架手术资料。采用酶联免疫吸附试验（ELISA）测定冠脉支架置入术前、术后6个月、术后12个月患者血清VEGF的水平，比较两组间VEGF的表达差异。
结果 ISR组及非ISR组患者术前VEGF水平无明显差异（499±39）ng/L vs（503±35）ng/L；术后两个时间点ISR组VEGF水平显著低于非ISR组（377±33）ng/L vs（462±56）ng/L；（184±34）ng/L vs（361±45）ng/L，差异均有统计学意义（均P<0.01）。Logistic回归分析表明：术后VEGF水平（OR=0.95，95%CI：0.92-0.97；P<0.01）是ISR的保护性因素；2型糖尿病（OR=14.81，95%CI：1.96-111.81；P<0.01）、术后吸烟（OR=32.74，95%CI：4.74-226.03；P<0.01）与ISR密切相关，是ISR的独立危险因素；支架长度（OR=1.26，95%CI：1.09-1.46；P<0.01）与ISR成正相关；支架直径（OR=0.03，95%CI：0.00-0.23；P<0.01）与ISR呈反相关。经绘制ROC曲线及支架直径、支架长度的联合指标的ROC曲线显示VEGF对ISR的预测价值较好，而VEGF联合支架长度及直径指标优于单独指标。
结论术后VEGF水平与ISR密切相关，是ISR的一项独立预测因素，可作为临床评估ISR的一项指标，而VEGF联合支架直径和支架长度指标对预测ISR效能最优。

Abstract:
AIM To explore the combined predictive value of vascular endothelial growth factor (VEGF), stent diameter and stent length for in-stent restenosis (ISR) patients after drug-eluting stent (DES) implantation.
METHODS From June 2014 to August 2016, 332 patients with unstable angina (UA) who underwent drug-eluting stent implantation in the Department of Cardiology, Chengde Central Hospital were selected for the study, including 178 males and 154 females. The patients were divided into ISR group (n= 41) and non-ISR group (n=291) according to the results of coronary angiography reexamination at 1 year after operation. General clinical data and coronary stent operation data of the two groups were compared. The serum VEGF levels of the patients before, 6 months and 12 months after coronary stent implantation were measured by enzyme-linked immunosorbent assay (ELISA) and the difference of VEGF expression between the two groups was compared.
RESULTS There was no significant difference in VEGF level between ISR group and non-ISR group before operation (499±39) ng/L vs. (503±35) ng/L. The VEGF level in ISR group was significantly lower than that in non-ISR group after operation (377±33 ng/L vs. (462±55) ng/L; (184±34) ng/L vs. (361±45)ng/L and the difference had statistical significance (all P<0.01). The results of logistic regression analysis showed that postoperative VEGF level was a protective factor for ISR (OR=0.95, 95% CI: 0.92-0.97, P<0.01). Type II diabetes mellitus (OR=14.81, 95% CI: 1.96-111.81, P<0.01) and heavy smoking after operation (OR=32.74, 95% CI: 4.74-226.03, P<0.01) were closely related to ISR, which were independent risk factors for ISR. Stent length (OR=1.26, 95% CI: 1.09-1.46, P<0.01) was positively correlated with ISR, and stent diameter (OR=0.03, 95% CI: 0.00-0.23; P<0.01) was inversely related to ISR. The ROC curve of the combined indexes of VEGF, stent diameter and stent length showed that VEGF had good predictive value for ISR. However, the combined indexes were better than a single predictive factor, including stent diameter, stent length and VEGF.
CONCLUSION Postoperative VEGF level is closely related to ISR, which is an independent predictor of ISR and can be used as an indicator for clinical assessment of in-stent restenosis in coronary artery. The combined indexes of VEGF, stent diameter and stent length are of the best efficiency in predicting ISR efficiency.

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