【摘要】 目的探讨可溶性髓系细胞触发受体-1(sTREM-1)对急性心肌梗死患者支架内再狭窄(ISR)的预测价值。方法选取2017年1月至2018年1月在朝阳市第二医院诊断及行经皮冠状动脉介入治疗(PCI)的冠心病患者215例,失访13例,对202例患者PCI术后12个月进行冠状动脉造影复查,根据是否发生ISR将患者分为狭窄组(24例)与对照组(178例),对比患者基线资料,PCI手术相关信息;对比患者PCI术后炎症及代谢因子水平,用Logistic回归分析ISR发生的独立危险因素,应用ROC曲线评估不同指标对ISR发生的预测效能,De Long法比较曲线下面积的差异。结果共发生24例ISR(11.88%),狭窄组在伴有糖尿病比例显著高于对照组(χ2=5.914,P <0.05),在支架直径及长度显著大于对照组(t=2.260,P <0.05),狭窄组在糖化血红蛋白(HbA1c)、同型半胱氨酸(Hcy)、超敏c反应蛋白(hs-CRP)、sTREM-1水平上显著高于对照组(t=4.557、4.519、11.832、13.790,均P <0.05),多因素Logistic回归显示高水平Hcy(OR=1.859,P <0.01)、高水平hs-CRP(OR=1.395,P <0.01)、高水平sTREM-1(OR=1.495,P <0.01)是ISR发生的独立危险因素,Hcy、hs-CRP、s TREM-1预测ISR发生的AUC分别为0.787、0.833、0.956,s TREM-1显著优于其他两项指标(P <0.05),s TREM-1诊断灵敏度显著优于Hcy(P <0.05)。结论PCI术后sTREM-1水平对急性心肌梗死患者ISR的发生具有一定预测价值。更多还原

【Abstract】 Objective To explore the predictive value of soluble triggering receptor expressedon myeloid-1(sTREM-1) for in-stent restenosis(ISR) in patients with acute myocardial infarction. Methods From January 2017 to January 2018, 215 patients with coronary heart disease treated with percutaneous coronary intervention(PCI) in the second hospital of Chaoyang were selected, coronary angiography was performed on all patients at 12 months after PCI, and patients were divided into stenosis group(24 cases) and control group(178 cases) according to whether ISR occurred. Baseline data, PCI information, the levels of inflammation and metabolic factors after PCI were also compared. Independent risk factors for ISR occurrence were analyzed by logistic regression, ROC curve was applied to evaluate the prediction efficiency of different indicators for ISR occurrence, and the difference of area under the curve was compared by De Long method. Results A total of 24 cases of ISR(11.88%) occurred in this study. The proportion of diabetes in stenosis group was significantly higher than control group(χ2=5.914, P < 0.05), and the diameter and length of stents were significantly higher than control group(t=2.260, P < 0.05). The levels of glycosylated hemoglobin(HbA1 c), homocysteine(Hcy), hypersensitive c-reactive protein(hs-CRP) and sTREM-1 in the stenosis group were significantly higher than control group(t=4.557, 4.519, 11.832, 13.790, all P < 0.05). Multivariate logistic regression showed that high level Hcy(OR=1.859, P < 0.01), high level hs-CRP(OR=1.395, P < 0.01), high level sTREM-1(OR=1.495, P < 0.01) were independent risk factors for ISR. The AUC of Hcy, hs-CRP and sTREM-1 for predicting ISR were 0.787, 0.833, 0.956, sTREM-1 was significantly better than the other two indicators(P < 0.05), the sensitivity of sTREM-1 was significantly higher than Hcy(P < 0.05). Conclusion The level of sTREM-1 after PCI may be predictive for ISR in patients with acute myocardial infarction.更多还原