杨蕾 邱瑾 杜劲 庞小燕 林焜云

【摘要】 目的：探討血清脂蛋白相关磷脂酶A2（Lp-PLA2）、脑钠肽（BNP）、可溶性凝集素样氧化低密度脂蛋白受体-1（sLOX-1）联合检测对急性心肌梗死（AMI）患者经皮冠状动脉介入（PCI）术后支架内再狭窄（ISR）的预测价值。方法：回顾性选取2020年1月—2022年1月在湛江中心人民医院行PCI术的200例AMI患者的临床资料，根据术后1年是否发生ISR分为ISR组和未ISR组（NISR）组。比较两组一般临床资料及PCI术前血清Lp-PLA2、BNP、sLOX-1水平和常规生化指标。利用logistic回归分析影响PCI术后发生ISR的影响因素。利用受试者操作特征（ROC）曲线分析相关因素预测PCI术后发生ISR的价值。结果：200例患者均经冠脉造影复查，发现有34例患者出现ISR，发生率为17.00%。ISR组合并糖尿病的患者占比高于NISR组，差异有统计学意义（P<0.05）；ISR组术前Lp-PLA2、BNP、sLOX-1、LDL-C水平均高于NISR组，差异均有统计学意义（P<0.05）；ISR组支架直径短于NISR组，支架数量多于NISR组，差异均有统计学意义（P<0.05）。多因素logistic回归分析结果显示，合并糖尿病、术前血清Lp-PLA2、BNP、sLOX-1高水平均为影响AMI患者PCI术后发生ISR的独立危险因素，支架直径长是保护因素（P<0.05）。ROC结果显示，术前血清Lp-PLA2、BNP、sLOX-1水平均具有预测AMI患者PCI术后发生ISR的价值（P<0.05），且联合检测价值高于各指标单独检测。结论：术前血清Lp-PLA2、BNP、sLOX-1水平均具有预测AMI患者PCI术后发生ISR的价值，联合检测可有效提升临床预测价值。

【关键词】 经皮冠状动脉介入 术后支架内再狭窄 脂蛋白相关磷脂酶A2 脑钠肽 可溶性凝集素样氧化低密度脂蛋白受体-1

Predictive Value of Combined Detection Serum Lp-PLA2， BNP and sLOX-1 for In-stent Restenosis in Patients with Acute Myocardial Infarction after PCI/YANG Lei， QIU Jin， DU Jin， PANG Xiaoyan， LIN Kunyun. //Medical Innovation of China， 2024， 21（07）： -131

[Abstract] Objective： To explore the predictive value of combined detection serum lipoprotein-associated phospholipase A2 （Lp-PLA2）， brain natriuretic peptide （BNP） and soluble lectin-like oxidized low density lipoprotein receptor-1 （sLOX-1） for in-stent restenosis （ISR） in patients with acute myocardial infarction （AMI） after percutaneous coronary intervention （PCI）. Method： The clinic data of 200 patients with AMI undergoing PCI in Central People's Hospital of Zhanjiang were enrolled between January 2020 and January 2022 were retrospectively selected， according to presence or absence of ISR at 1 year after surgery， they were divided into ISR group and no-ISR （NISR） group. The general clinical data， levels of serum Lp-PLA2， BNP， sLOX-1 and routine biochemical indexes before PCI were compared between the two groups. The influencing factors of ISR after PCI were analyzed by logistic regression analysis. The predictive value of the correlated factors for ISR after PCI was analyzed by receiver operating characteristic （ROC） curves. Result： All 200 patients underwent coronary angiography reexamination， and 34 patients were found to have ISR， with an incidence of 17.00%. The proportion of patients with diabetes in the ISR group was higher than that in the NISR group， the difference was statistically significant （P<0.05）. The preoperative levels of Lp-PLA2， BNP， sLOX-1 and LDL-C in ISR group were higher than those in NISR group， the differences were statistically significant （P<0.05）. The diameter of stents in ISR group was shorter than that in NISR group， and the number of stents was more than that in NISR group， the differences were statistically significant （P<0.05）. The results of multivariate logistic regression analysis showed that diabetes mellitus and preoperative high levels of serum Lp-PLA2， BNP and sLOX-1 were independent risk factors of ISR in AMI patients after PCI， while long stent diameter was a protective factor （P<0.05）. The results of ROC curves analysis showed that serum Lp-PLA2， BNP and sLOX-1 were all valuable in predicting ISR in AMI patients after PCI （P<0.05）， and the predictive value of combined detection was greater than those of single indexes. Conclusion： Preoperative serum Lp-PLA2， BNP and sLOX-1 all have predictive value for ISR in AMI patients after PCI， and combined detection can effectively improve clinical predictive value.

[Key words] Percutaneous coronary intervention Postoperative in-stent restenosis Lipoprotein-associated phospholipase A2 Brain natriuretic peptide Soluble lectin-like oxidized low density lipoprotein receptor-1

First-author's address： Department of Laboratory Medicine， Central People's Hospital of Zhanjiang， Zhanjiang 524000， China

doi：10.3969/j.issn.1674-4985.2024.07.030

急性心肌梗死（acute myocardial infarction，AMI）是由于冠状动脉阻塞而导致的部分心肌急性缺血坏死，可危及患者生命[1]。目前急诊经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）是其主要治疗手段，可有效再通肇事血管，恢复血供，以挽救患者生命。然而尽管冠状动脉支架材料的不断改进与创新，PCI后支架内再狭窄（in-stent restenosis，ISR）的发生率仍较高[2-3]，对患者术后恢复造成严重影响，易使患者再发心肌梗死，甚至出现心源性猝死，对患者的生命安全具有较大的威胁。冠脉造影复查是发现ISR的金标准，但因其操作复杂，重复性较差，临床使用仍有限。既往研究已证实ISR的发病机制可能与内皮细胞损伤，血液脂质成分增加，引起动脉粥样硬化及血管弹性回缩、血管重构、炎症反应等有关[4-5]。……