摘要
目的探讨冠状动脉粥样硬化性心脏病(冠心病,CHD)患者在经皮冠状动脉介入术(PCI)前和术后血清血管紧张素Ⅱ-1型受体自身抗体(AT1-AA)滴度的变化及其与支架内再狭窄(ISR)的关系。方法选取2018年10月至2020年1月于联勤保障部队第九八九医院心内科行标准PCI(药物洗脱支架)的急性冠脉综合征(ACS)患者145例,PCI前和术后24 h采集血样,采用SA-ELISA法检测血清AT1-AA滴度。根据术后随访冠状动脉(冠脉)造影结果,将患者分为ISR组(ISR≥50%)和非ISR组(ISR<50%)。另外检测血清白细胞介素-6(IL-6)、C反应蛋白(CRP)、γ-干扰素(IFN-γ)、血管内皮生长因子(VEGF)、血管生成素1(Ang-1)、Ang-2水平。结果随访期间,43例患者发生ISR,发生率为29.66%。两组PCI术前血清AT1-AA滴度阳性率比较无差异(P>0.05)。PCI后,ISR组患者血清AT1-AA滴度阳性率高于PCI术前和非ISR组(P<0.05)。经多因素Logistic回归分析,PCI后AT1-AA滴度值是ISR发生的独立预测因素(OR=2.083,95%CI:1.195~3.47,P<0.05)。另对于ISR组患者与AT1-AA滴度阴性亚组患者比较,AT1-AA滴度阳性亚组患者血清IL-6、CRP、IFN-γ、VEGF、Ang-2水平更高(P均<0.05)。结论PCI后血清AT1-AA滴度阳性与ISR的发生风险存在独立的相关性,可能与冠脉内皮细胞受损及内膜增生有关,检测血清AT1-AA滴度的分布特征有助于预测PCI术后ISR的发生。
Objective To investigate the changes of serum AT1 agonistic autoantibody(AT1-AA)titer before and after PCI and correlation between it and in-stent restenosis(ISR)in patients with coronary heart disease(CHD).Methods ACS patients(n=145)undergone PCI(drug eluting stent)were chosen from Department of Cardiology in the 989th Hospital of Chinese PLA Joint Logistics Support Force from Oct.2018 to Jan.2020.The blood samples were collected before PCI and after PCI for 24 h,and AT1-AA titer was detected by using SA-ELISA.According to results of coronary angiography(CAG)during follow-up after PCI,all patients were divided into ISR group(ISR≥50%)and non-ISR group(ISR<50%).The levels of serum interleukin-6(IL-6),C-reactive protein(CRP),interferon-γ(IFN-γ),vascular endothelial growth factor(VEGF),angiogenin-1(Ang-1)and Ang-2 were detected.Results During follow-up period,ISR occurred in 43 patients(29.66%).The positive rate of AT1-AA titer had no difference between 2 groups before PCI(P>0.05).After PCI,positive rate of AT1-AA titer was higher in ISR group than that before PCI and in non-ISR group(P<0.05).The results of multi-factor Logistic regression analysis showed that AT1-AA titer value after PCI was an independent predictive factor of ISR(OR=2.083,95%CI:1.195~3.47,P<0.05).In ISR group,the levels of IL-6,CRP,IFN-γ,VEGF and Ang-2 were higher in negative AT1-AA titer subgroup than those in positive AT1-AA titer subgroup(all P<0.05).Conclusion There is an independent correlation between positive AT1-AA titer and ISR risk after PCI,which may be related to coronary endothelial cell injury and intimal hyperplasia.Therefore,the detection of serum AT1-AA titer distribution is helpful to predict ISR occurrence after PCI.
作者
任于军
张国勇
张明德
曹应江
邹洋
卜建学
Ren Yujun;Zhang Guoyong;Zhang Mingde;Cao Yingjiang;Zou Yang;Bu Jianxue(Department of Cardiology,989th Hospital of Chinese PLA Joint Logistics Support Force,Luoyang 471000,China)
出处
《中国循证心血管医学杂志》
2021年第9期1108-1111,1114,共5页
Chinese Journal of Evidence-Based Cardiovascular Medicine
关键词
急性冠脉综合征
经皮冠状动脉介入术
支架内再狭窄
血清AT1-AA滴度
炎症
Acute coronary syndrome
Percutaneous coronary intervention
In-stent restenosis
Serum AT1 agonistic autoantibody titer
Inflammation
