【作者】 王萍；

【导师】 马琦琳；

【作者基本信息】 中南大学 ， 临床医学（专业学位）， 2022， 硕士

【摘要】 目的:经皮冠状动脉介入术(percutaneous coronary intervention,PCI)是治疗冠心病的重要手段之一,支架植入术后发生的支架内再狭窄(in-stent restenosis,ISR)是影响冠心病远期疗效及预后的重要因素。本研究旨在探讨血浆QKI(Quaking)、环氧酶2(Cyclooxygenase2,COX2)水平与冠心病患者PCI术后ISR的相关性。方法:连续选取在我院行冠脉造影并行支架植入术的冠心病患者218例,选取同期在体检中心体检的与冠心病患者基线资料相匹配的35例个体作为对照组。入院后收集两组患者临床资料,采用酶联免疫吸附法(ELISA)测定血浆QKI、COX2水平。术后12个月复查冠心病患者的冠脉造影,根据是否发生ISR将218例冠心病患者分为非再狭窄组(NISR,n=160)与再狭窄组(ISR,n=58)。比较NISR组与ISR组的一般资料及冠状动脉临床指标,采用多因素Logistic回归分析ISR的影响因素。记录1年内主要不良心血管事件(major adverse cardiovascular events,MACE)发生情况,并据此将58例PCI术后ISR患者分为未发生MACE组(34例)与发生MACE组(24例),比较此两组的血浆QKI、COX2水平,采用受试者工作特征(ROC)曲线探究血浆QKI、COX2水平对PCI术后ISR及MACE的诊断价值。结果:与对照组相比,冠心病组COX2及QKI水平明显下降(均P<0.001)。与NISR组相比,ISR组超敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)、糖化血红蛋白(glycosylated hemoglobin,Hb Alc)显著升高(均P<0.001),COX2及QKI水平明显下降(均P<0.001)。血浆COX2与hs-CRP水平呈负相关(P=0.003)。多因素Logistic回归分析发现血浆QKI、COX2是冠心病患者PCI术后ISR的保护因素,hs-CRP是危险因素。ROC曲线分析显示:血浆QKI诊断冠心病患者PCI术后ISR的灵敏度为77.5%,特异度为65.5%;血浆COX2的灵敏度为80.8%,特异度为70.7%。血浆QKI联合COX2的灵敏度为81.3%,特异度为74.1%。血浆QKI预测PCI术后ISR患者发生MACE的灵敏度为75.0%,特异度为64.7%;血浆COX2的灵敏度为75.0%,特异度为70.6%;血浆QKI联合COX2的灵敏度为81.7%,特异度为79.4%。血浆QKI联合COX2对冠心病患者PCI术后ISR的发生及MACE预测的灵敏度、特异度均优于单独应用QKI或COX2。结论:血浆QKI、COX2可能是冠心病患者PCI术后ISR的保护因素之一,其水平可为冠心病患者PCI术后ISR的发生及患者预后提供一定的预测价值。图2幅,表8个,参考文献115篇更多还原

【Abstract】 Objective: Percutaneous coronary intervention(PCI)is one of the important methods for the treatment of coronary artery disease(CAD).In-sent restenosis(ISR)after PCI for patients suffered from CAD is considered to be an essential factor affecting long-term outcomes and prognosis of this disease.This study aims to investigate the correlation between plasma Quaking(QKI)and cyclooxygenase 2(COX2)levels and ISR in patients with CAD.Methods:218 consecutive CAD patients who underwent coronary angiography and coronary arterial stenting were enrolled in this study,and 35 matched individuals from the physical examination center were included as a control group.After admission,clinical data of these two groups were collected.Plasma QKI and COX2 levels were measured by an enzyme-linked immune sorbent assay(ELISA)test.Follow-up angiography was performed 12 months after PCI.CAD patients were divided into NISR group(n=160)and ISR group(n=58)according to ISR occurrence based on the coronary angiography.The clinical data,coronary angiography,and stent features between NISR group and ISR group were compared,and multivariate logistic regression was used to explore the factors influencing ISR.The occurrence of major adverse cardiovascular events(MACE)1 year after operation was recorded.58 patients with ISR were divided into the MACE group(n=24)and the non-MACE group(n=34),classified according to the occurrence of MACE,and the plasma QKI and COX2 levels were compared between these two groups.ROC curves were utilized to analyze the diagnostic value of plasma levels of QKI and COX2 for ISR and MACE occurrences in patients after PCI.Results: Compared with the control group,plasma QKI and COX2 levels in the CAD group decreased significantly(all P<0.001).Compared with the NISR group,the levels of QKI and COX2 also reduced markedly in the ISR group(all P<0.001).In contrast,the levels of high sensitivity C-reactive protein(hs-CRP)and glycosylated hemoglobin(Hb Alc)were significantly increased(all P<0.001).The level of COX2 was negatively correlated with hs-CRP(P=0.003).Multivariate Logistic regression analysis showed that plasma QKI and COX2 were protective factors for in-stent restenosis after PCI,while hsCRP was a risk factor.ROC curve analysis shows that the sensitivity and specificity of plasma QKI for evaluating the predictive value of ISR were 77.5% and 66.5%,and the sensitivity and specificity of plasma COX2 for assessing the predictive value of ISR were 80.0% and 70.7%.The sensitivity and specificity of plasma QKI combined with COX2 for evaluating the predictive value of ISR were 81.3% and 74.1%,respectively.The sensitivity and specificity of plasma QKI for evaluating the prognosis of ISR were 75.0% and 64.7%,respectively.The sensitivity and specificity of plasma COX2 for evaluating the prognosis of ISR were 75.0% and 70.6%,respectively.The sensitivity and specificity of plasma QKI combined with COX2 for prognostic evaluation of ISR were 81.7% and 79.4%,respectively.The sensitivity and specificity of plasma COX2 combined with QKI for evaluating ISR and MACE occurrences in patients after PCI were better than those of COX2 or QKI alone(P<0.001).Conclusion: Plasma QKI and COX2 may be one of the protective factors for ISR,which also can predict an ISR patient’s prognosis.更多还原