Lp-PLA2、PTX3对冠心病患者PCI术后支架内再狭窄的预测价值

李令娟; 刘冬; 王卫娟; 王宏伟; 孙美娜

doi:10.12125/j.chj.202204064

摘要:

目的探讨脂蛋白相关性磷脂酶 A2（Lp-PLA2）、正五聚蛋白-3（PTX3）对冠状动脉粥样硬化性心脏病（CHD）患者经皮冠状动脉介入（PCI）术后支架内再狭窄（ISR）的预测价值。

方法选取因冠状动脉严重狭窄行PCI治疗的CHD患者379例。根据术后6个月复查是否发生ISR，分为ISR组（n=53)、非ISR组(n=326)。收集两组一般临床资料，监测两组术后1 d的 Lp-PLA2和PTX3水平。采用Logistic 逐步回归分析ISR发生的危险因素。术后6个月复查外弹力膜横截面积（EEM-CSA）、斑块面积（PLA）、最小管腔面积（MLA），内膜面积（IPA）及Gensini 积分。分析Lp-PLA2和PTX3与Gensini 积分、EEM-CSA、MLA、PLA、IPA的相关性。采用ROC曲线评估Lp-PLA2和PTX3预测ISR的最佳截断值与AUC。

结果 ①ISR组STEMI（P<0.05）、吸烟史（P<0.01）、糖尿病（P<0.01）、LDL-C（P<0.05）、支架串联（P<0.05）、应用分叉术式（P<0.01）、支架置入时长（P<0.01）、Lp-PLA2（P<0.05）、PTX3（P<0.01）高于非ISR组，HDL-C、LVEF、用药依从性低于非ISR组（均P < 0.05）。吸烟（P<0.01）、LDL-C（P<0.01）、应用分叉术式（P<0.01）、糖尿病（P<0.01）、药物服用依从性（P<0.01）、Lp-PLA2（P<0.05）、PTX3（P<0.05）为ISR发生的独立危险因素。②ISR组Gensini 积分高于非ISR组（P<0.01），与非ISR组相比，ISP组有更大的IPA、PLA（均P<0.05）及更小的EEM-CSA、MLA（均P<0.01）。Lp-PLA2、PTX3与Gensini 积分、IPA、PLA呈正相关（均P<0.01），与EEM-CSA（均P<0.05）、MLA呈负相关（均P<0.01）。③Lp-PLA2、PTX3预测ISR的最佳截断值分别为310.65 ng/mL和3.87 ng/mL，AUC分别为0.780（95%CI：0.739～0.861）、0.751（95%CI：0.722～0.897），Lp-PLA2联合PTX3预测ISR的AUC为0.832（95%CI：0.817～0.933），明显高于Lp-PLA2、PTX3单独预测 (Z=3.083，P=0.021；Z=3.697，P=0.017)。

结论 ISR患者PCI术后有较高水平的Lp-PLA2、PTX3, 术后Lp-PLA2、PTX3水平监测有助于ISR发生风险预测，联合检测可提升ISR的预测价值。

Abstract:

AIM To investigate the predictive value of lipoprotein-associated phospholipase A2(Lp-PLA2) and pentraxin 3(PTX3) for in-stent restenosis (ISR) after percutaneous coronary intervention (PCI) in patients with coronary atherosclerotic heart disease (CHD).

METHODS A total of 379 CHD patients undergoing PCI for severe coronary artery stenosis were selected. According to the reexamination of ISR 6 months after the operation, 53 cases were divided into ISR group and 326 cases were non-ISR group. General clinical data of patients in both groups were collected. Lp-PLA2 and PTX3 levels in both groups were monitored 1d after surgery. Logistic stepwise regression was used to analyze the risk factors of ISR.The cross-sectional area of the elastic membrane (EEM-CSA), plaque area (PLA), minimum lumen area (MLA), intima proliferation area (IPA) and Gensini score were reviewed 6 months after the operation. The correlation of Lp-PLA2 and PTX3 with Gensini score, EEM-CSA, MLA, PLA, IPA was analyzed. The optimum cut-off value and AUC of Lp-PLA2 and PTX3 for predicting ISR were evaluated by ROC curve.

RESULTS (1) STEMI (P<0.05), smoking history (P<0.01), diabetes (P<0.01), LDL-C (P<0.05), stent tandem (P<0.05), bifurcation operation (P<0.01), stent placement duration (P<0.01), LP-PLA2 (P<0.05) and PTX3 (P<0.01) were higher in ISR group than in non-ISR group, HDL-C, LVEF and medication compliance were lower in ISR group than in non-ISR group (ALL P<0.05). Smoking (P<0.01), LDL-C (P<0.01), bifurcation procedure (P<0.01), diabetes (P<0.01), medication compliance (P<0.01), LP-PLA2 (P<0.05) and PTX3 (P<0.05) were independent risk factors for ISR. (2) The Gensini score of ISR group was higher than that of non-ISR group (P<0.01). Compared with the non-ISR group, the ISR group had larger IPA, PLA (all P<0.05) and smaller EM-CSA and MLA (all P<0.01). Lp-PLA2 and PTX3 were positively correlated with Gensini score, IPA and PLA (all P<0.01), but negatively correlated with EEM-CSA (all P<0.05) and MLA (all P<0.01). (3) The optimal truncation values of Lp-PLA2 and PTX3 for predicting ISR were 310.65 ng/ mL and 3.87 ng/ mL, respectively, and AUC were 0.780 (95%CI: 0.739-0.861) and 0.751 (95%CI: 0.751), respectively.The AUC of ISR predicted by LP-PLA2 combined with PTX3 was 0.832 (95%CI: 0.817-0.933), which was significantly higher than that predicted by LP-PLA2 and PTX3 alone (Z=3.083, P=0.021; Z=3.697, P=0.017).

CONCLUSION ISR patients have higher lP-PLA2 and PTX3 levels after PCI, and monitoring of lP-PLA2 and PTX3 levels after PCI is helpful to predict the risk of ISR occurrence, the combined detection enhances the predictive value of ISR.

Lp-PLA2、PTX3对冠心病患者PCI术后支架内再狭窄的预测价值

Predictive value of Lp-PLA2 and PTX3 for ISR after PCI in CHD patients