【作者】 杨明；

【导师】 王智慧；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2023， 硕士

【摘要】 研究背景:经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)已经成为冠心病患者血运重建的首选方式,但是术后再狭窄的并发症仍然难以彻底解决。研究表明炎症反应是导致支架内狭窄(in-stent restenosis,ISR)的重要原因之一。全身免疫炎症指数(systemic immune inflammation index,SII)、系统性炎症反应指数(systemic inflammatory response index,SIRI)是新提出的炎症指标,可能是参与ISR机制的重要因素。载脂蛋白B/载脂蛋白A1(Apo B/Apo A1)比值反映了致动脉粥样硬化和抗动脉粥样硬化之间的平衡,并且在ISR的动脉粥样硬化形成中发挥了关键作用。本文旨在探讨SII、SIRI、Apo B/Apo A1在药物洗脱支架植入术后再狭窄的作用。目的:通过回顾性分析,探索SII、SIRI及Apo B/Apo A1与冠状动脉支架植入术后支架内再狭窄的影响,为支架内再狭窄发生发展提供一定的预测价值。方法:连续收集2014年1月至2022年12月在吉林大学第二医院心血管内科首次接受冠状动脉药物洗脱支架植入术,并在术后6个月以上复查1次冠脉造影(Coronary Arteriography,CAG)检查的298例冠心病患者的相关病历进行回顾性分析,根据术后复查的冠状动脉造影结果分为ISR组(n=54)和non-ISR组(n=244)。收集入组患者的基本临床资料(包括年龄、性别、糖尿病病史、高血压史等指标)、实验室检查结果(红细胞、白细胞、血小板、中性粒细胞、淋巴细胞、单核细胞、高密度脂蛋白胆固醇、甘油三酯、低密度脂蛋白胆固醇、尿素氮等化验指标)、辅助检查结果(左室射血分数、左室舒张末容积)、冠脉造影结果及支架特征(病变部位、病变靶血管数量、支架植入数量、单枚支架的最长长度、支架植入的最小直径等指标)。利用统计学方法分析SII、SIRI及Apo B/Apo A1与ISR之间的相关性。结果:1.ISR组和non-ISR组的实验室检查及辅助检查比较中,白细胞、中性粒细胞、血小板、血小板压积、D-二聚体、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、总胆固醇、Apo B、Apo B/Apo A1、SII、SIRI差异均有统计学意义(P<0.05)。2.以ISR为因变量,进行多因素Logistic回归分析显示:SII(P<0.001,OR:1.005,95%CI:1.003-1.007)、Apo B/Apo A1(P=0.024,OR:24.831,95%CI:1.535-401.615)是发生支架内再狭窄的独立危险因素。3.ROC预测曲线分析显示:SII预测ISR曲线下面积为0.774(95%CI:0.713-0.834,P<0.001),当约登指数最大时,SII对应的值为504.76,灵敏度为87.00%,特异度为55.30%;Apo B/Apo A1预测ISR曲线下面积为0.677(95%CI:0.596-0.758,P<0.001),当约登指数最大时,Apo B/Apo A1对应的值为0.58,灵敏度为74.10%,特异度为58.20%;SII、Apo B/Apo A1联合预测ISR曲线下面积为0.822(95%CI:0.767-0.877,P<0.001),当约登指数最大时,灵敏度为87.00%,特异度为65.20%。结论:1.SII、Apo B/Apo A1是PCI术后ISR的可预测指标。2.SII、Apo B/Apo A1对药物洗脱支架再狭窄发生均有一定预测价值,两者联合较单独应用的预测价值更高。更多还原

【Abstract】 Background :Percutaneous coronary intervention(PCI)has become the preferred modality for revascularization in patients with coronary artery disease,but the post-procedural complications of restenosis remain a difficult challenge to completely resolve.Studies have shown that inflammatory response is one of the important causes of in-stent restenosis(ISR),and systemic immune inflammation index(SII),systemic inflammatory response index(SIRI)systemic inflammatory response index(SIRI)are new inflammatory indices proposed so far,which may be important factors involved in the mechanism of ISR.Apolipoprotein B/(apolipoprotein B,Apo B)reflects the atherogenic effect while apolipoprotein A1(Apo A1)has an anti-atherogenic effect,and the Apo B/Apo A1 ratio reflects the balance between these two effects,while recent studies have shown that new atherogenesis is a key factor in ISR mechanism.In this paper,we investigate the role of SII,SIRI,and Apo B/Apo A1 in restenosis after drugeluting stent implantation.Objective :Through retrospective analysis,the effects of SII,SIRI,and Apo B / Apo A1 on instent restenosis after coronary stent implantation were explored,which provided certain predictive value for the occurrence and development of in-stent restenosis.Methods :The medical records related to 298 patients with coronary artery disease who underwent coronary drug-eluting stent implantation for the first time at the Department of Cardiovascular Medicine,The Second Hospital of Jilin University from January2014 to December 2022 and had one coronary arteriography(CAG)review more than6 months after the procedure were retrospectively collected and analyzed according to the coronary arteriography reviewed after the procedure.The results were divided into two groups,the ISR group(n=54)and the non-ISR group(n=244).Basic clinical information(including age,gender,history of diabetes,history of hypertension,and other indicators),laboratory findings(erythrocytes,leukocytes,platelets,neutrophils,lymphocytes,monocytes,HDL cholesterol,triglycerides,LDL cholesterol,urea nitrogen,and other laboratory indicators),ancillary findings(left ventricular ejection fraction,left ventricular end-diastolic volume),the results of the enrolled patients’ coronary angiography results and stent characteristics(lesion site,number of diseased target vessels,number of stent implantations,longest length of single stent,minimum diameter of stent implantation,and other indicators).Correlations between SII,SIRI,Apo B/Apo A1,and ISR were analyzed using statistical methods.Result:1.In the comparison of laboratory tests and ancillary tests between the ISR and non-ISR groups,the differences in white blood cell count,neutrophil count,platelet count,platelet pressure,D-dimer,low-density lipoprotein cholesterol(LDL-C),total cholesterol,Apo B,Apo B/ Apo A1,SII,and SIRI were statistically significant(P < 0.05).2.Multi-factor logistic regression analysis with ISR as the dependent variable sho wed that SII(P<0.001,OR: 1.005,95% CI: 1.003-1.007),Apo B/Apo A1(P=0.024,OR:24.831,95% CI: 1.535-401.615)were the independent risk factor for the occurrence o f in-stent restenosis.3.ROC prediction curve analysis showed that the area under the ISR curve predi cted by SII was 0.774(95% CI: 0.713-0.834,P < 0.001),and the corresponding value of SII at the maximum of the Yordon index was 504.76,with a sensitivity of 87.00% a nd specificity of 55.30%;the area under the ISR curve predicted by Apo B/Apo A1 was0.677(95% CI: 0.596-0.758,P < 0.001),the value corresponding to Apo B/Apo A1 at t he maximum of the Jorden index was 0.58,with a sensitivity of 74.10% and a specific ity of 58.20%;the area under the ISR curve predicted by the combination of SII and A po B/Apo A1 was 0.822(95% CI: 0.767-0.877,P < 0.001),and when the Jorden index was maximum,the sensitivity was 87.00% and the specificity was 65.20%.Conclusion :1.SII,Apo B/ Apo A1 are predictable indicators of ISR after PCI.2.Both SII and Apo B/Apo A1 have a predictive value for the occurrence of restenosis in drug-eluting stents,and the combination of the two has a higher predictive value than their individual application.更多还原