【摘要】 目的 研究冠心病患者血清消皮素D(gasdermin D,GSDMD)、白细胞介素-1β(interleukin-1β,IL-1β)、白细胞介素-18(interleukin-18,IL-18)水平与冠心病患者冠状动脉粥样硬化斑块稳定性的相关性。方法 收集2017年10月～2020年12月于哈尔滨医科大学附属第五医院心内科二病区收治住院的冠心病患者97例，根据血管内超声(intravascular ultrasound, IVUS)检查结果分为易损斑块组(55例)、稳定斑块组(42例)。比较两组患者一般资料；利用酶联免疫吸附法(enzyme-linked immuno sorbent assay, ELISA)检测患者血清GSDMD、IL-1β、IL-18水平；利用受试者工作特征曲线(receiver operating characteristic curve, ROC曲线)评价血清GSDMD、IL-1β、IL-18对患者斑块稳定性的诊断价值；运用Logistic分析方法预测患者斑块稳定性的危险因素。结果 易损斑块组和稳定斑块组男性患者比例、患者年龄、体质指数(body mass index, BMI)、吸烟史、糖尿病史、高血压史以及血脂水平均无显著性差异(P>0.05);与稳定斑块组患者比较，易损斑块组患者血清GSDMD、IL-1β、IL-18表达水平均明显升高，差异有统计学意义(P<0.05)。ROC曲线结果显示，血清GSDMD、IL-1β、IL-18诊断易损斑块的曲线下面积(area under the curve, AUC)分别为0.782(95%CI:0.690～0.874)、0.647(95%CI:0.536～0.757)、0.680(95%CI:0.572～0.787),敏感度分别为0.800、0.582、0.491,特异度分别为0.738、0.714、0.857。Logistic回归分析结果表明，血清GSDMD、IL-1β、IL-18水平可作为冠心病患者发生易损斑块的独立危险因素(P均<0.05)。结论 血清GSDMD、IL-1β、IL-18水平对判断冠心病斑块稳定性具有一定的诊断价值，血清GSDMD、IL-1β、IL-18水平高是冠心病患者发生易损斑块的独立危险因素。更多还原

【Abstract】 Objective To investigate the correlation between the serum levels of gasdermin D(GSDMD), interleukin-1β(IL-1β), interleukin-18(IL-18) and the stability of coronary athe-rosclerotic plaque. Methods Ninty-seven patients with coronary heart disease(CHD) hospitalized in the Department of Cardiology of the Fifth Affiliated Hospital of Harbin Medical University from October 2017 to December 2020 were sub-grouped into vulnerable plaque(55 cases) and stable plaque group(42 cases) according to intravascular ultrasound(IVUS) examination. The general data of the two groups were compared. The serum level of GSDMD, IL-1β and IL-18 were detected by enzyme-linked immunosorbent assay(ELISA); The diagnostic values of serum GSDMD, IL-1β and IL-18 for plaque stability were evaluated by receiver operating characteristic(ROC) curve, and Logistic Regression analysis was used to predict the risk factors of plaque stability. Results There was no significant difference in the proportion of male patients, age, body mass index(BMI), smoking history, diabetes history, hypertension history and blood lipid level between vulnerable plaque group and stable plaque group(P>0.05); the levels of serum GSDMD, IL-1β and IL-18 in vulnerable plaque group were significantly higher than those in stable plaque group(P<0.05). The results of ROC showed that the area under the curve(AUC) of GSDMD, IL-1β and IL-18 in the diagnosis of plaque stability were 0.782(95%CI: 0.690～0.874), 0.647(95%CI: 0.536～0.757), 0.680(95%CI: 0.572～0.787), respectively; the sensitivity were 0.800, 0.582, 0.491, respectively; the specificity were 0.738, 0.714, 0.857, respectively. The results of Logistic regression analysis showed that higher level of serum GSDMD, IL-1β and IL-18 were the independent risk factors of plaque stability in patients with CHD(P<0.05). Conclusion The serum levels of GSDMD, IL-1β and IL-18 are promising predictors for coronary atherosclerotic plaque stability. Higher levels of serum GSDMD, IL-1β and IL-18 are independent risk factors for CHD.更多还原