【摘要】 目的探讨微小核糖核酸-21(mi RNA-21)、金属基质蛋白酶-9(MMP-9)、骨桥蛋白(OPN)水平变化在PCI患者术后支架内再狭窄中的预测价值。方法选择2014年1月~2016年1月于郑州市中心医院心内科收治的PCI支架置入术后复查冠状动脉造影患者110例作为研究对象,按照冠状动脉造影结果分为再狭窄组(n=17)和未再狭窄组(n=93),两组患者均于复查时检测血清mi RNA-21表达水平及MMP-9、OPN、血脂等生化指标,对比两组患者的临床资料及血清mi RNA-21、MMP-9、OPN、血脂等表达水平。结果再狭窄组患者的支架置入数量较未再狭窄组少,支架直径较未再狭窄组小,累及前降支、三支病变例数明显多于未再狭窄组,再狭窄组患者的mi RNA-21、CRP、MMP-9及OPN表达水平均显著升高,上述差异均有统计学意义(P<0.05)。经多因素Logistic回归分析,mi RNA-21、OPN及MMP-9表达水平升高均是发生术后支架内再狭窄的独立危险因素(P均<0.05),较大的支架直径是支架置入术后再狭窄的保护因素(P<0.05)。血清mi RNA-21、OPN、MMP-9单项及联合检测的ROC曲线下ACU面积分别为0.898、0.782、0.739及0.977,联合检测可增加预测的特异性(94.62%)、准确性(90.91%)及阳性预测值(94.62%)。结论 Mi RNA-21、OPN及MMP-9表达水平升高与PCI患者术后支架内再狭窄关系密切,联合检测对PCI患者术后支架内再狭窄具有较高的预测价值。更多还原

【Abstract】 Objective To investigate the predictive value of level changes of mi RNA-21, matrix metalloproteinase-9(MMP-9) and osteopontin(OPN) in patients with postoperative restenosis after percutaneous coronary intervention(PCI). Methods The patients(n=110) undergone rechecks of coronary angiography(CAG) after PCI were chosen from Department of Cardiology of Central Hospital of Zhengzhou City from Jan. 2014 to Jan. 2016. All patients were divided, according to results of CAG, into restenosis group(n=17) and non-restenosis group(n=93). The expression of serum mi RNA-21, and changes of MMP-9, OPN and blood fat were detected in 2 groups during recheck. The clinical data, expression of serum mi RNA-21, and changes of MMP-9, OPN and blood fat were compared between 2 groups. Results The quantity of implanted stents were less, stent diameter was lower and cases of lesions involved anterior descending branch and 3 vessels were significantly more in restenosis group than those in non-restenosis group. The expressions of mi RNA-21, CRP, MMP-9 and OPN all increased significantly in restenosis group compared with non-restenosis group(P<0.05). The results of multi-factor Logistic regression analysis showed that increases of mi RNA-21, OPN and MMP-9 were independent risk factors of postoperative instent restenosis(all P<0.05), and higher stent diameter was a protective factor(P<0.05). The ACU of ROC of single mi RNA-21 detection was 0.898, single OPN, 0.782, single MMP-9. 0.739, and ACU of ROC of combined detection of them was 0.977. The combined detection improved the predictive specificity(94.62%), accuracy(90.91%) and positive predictive value(94.62%). Conclusion Increased expressions of mi RNA-21, OPN and MMP-9 are closely related to postoperative restenosis after PCI, and combined detection of mi RNA-21, OPN and MMP-9 has higher value in predicting postoperative in-stent restenosis.更多还原