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 (COX-2) levels and ISR in patients with CAD.
METHODS: A total of 218 consecutive CAD patients who underwent coronary angiography and coronary arterial stenting from September 2019 to September 2020 in the Department of Cardiology of Xiangya Hospital of Central South University were enrolled in this study, and 35 matched individuals from the physical examination center were served as a control group. After admission, clinical data of these 2 groups were collected. Plasma QKI and COX-2 levels were measured by enzyme linked immunosorbent assay (ELISA). Follow-up angiography was performed 12 months after PCI. CAD patients were divided into a NISR group (n=160) and an ISR group (n=58) according to the occurrence of ISR based on the coronary angiography. The clinical data, coronary angiography, and stent features between the NISR group and the 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. Fifty-eight patients with ISR were divided into an MACE group (n=24) and a non-MACE group (n=34), classified according to the occurrence of MACE, and the plasma levels of QKI and COX-2 were compared between the 2 groups. Receiver operating characteristic (ROC) curves were utilized to analyze the diagnostic value of plamsa levels of QKI and COX-2 for ISR and MACE occurrences in patients after PCI.
RESULTS: Compared with control group, plasma levels of QKI and COX-2 in the CAD group decreased significantly (all P<0.001). Compared with the NISR group, the plasma levels of QKI and COX-2 also decreased obviously in the ISR group (all P<0.001), while the levels of high sensitivity C-reactive protein (hs-CRP) and glycosylated hemoglobin (HbAlc) significantly increased (all P<0.001). The level of COX-2 was negatively correlated with hs-CRP (r=-0.385, P=0.003). Multivariate logistic regression analysis showed that high level of plasma QKI and COX-2 were protective factors for in-stent restenosis after PCI, while hs-CRP was a risk factor. ROC curve analysis showed that the sensitivity and specificity of plasma QKI for evaluating the predictive value of ISR were 77.5% and 66.5%, respectively, and the sensitivity and specificity of plasma COX-2 for evaluating the predictive value of ISR were 80.0% and 70.7%, respectively. The sensitivity and specificity of plasma QKI combined with COX-2 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 COX-2 for evaluating the prognosis of ISR were 75.0% and 70.6%, respectively. The sensitivity and specificity of plasma QKI combined with COX-2 for prognostic evaluation of ISR were 81.7% and 79.4%, respectively. The sensitivity and specificity of plasma COX-2 combined with QKI for evaluating ISR and MACE occurrences in patients after PCI were better than those of COX-2 or QKI alone (P<0.001).
CONCLUSIONS: High level of plasma QKI and COX-2 might be a protective factor for ISR, which can also predict ISR patient\'s prognosis.
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)是影响冠心病患者PCI术后远期疗效及预后的重要因素。本研究旨在探讨血浆
Quaking(QKI)、环氧合酶-2(cyclooxygenase-2,COX-2)水平与冠心病患者PCI术后ISR的相关性。方法: 连续选取2019年9月至2020年9月在中南大学湘雅医院心血管内科行冠状动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的临床资料,采用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)测定血浆QKI、COX-2水平。术后12个月复查冠心病患者的冠状动脉造影,根据是否发生ISR将218例冠心病患者分为无再狭窄组(NISR组,n=160)与再狭窄组(ISR组,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),比较两组的血浆QKI、COX-2水平,采用受试者操作特征(receiver operating characteristic,ROC)曲线探究血浆QKI、COX-2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COX-2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,HbAlc)显著升高(均P<0.001),COX-2及QKI水平明显下降(均P<0.001)。血浆COX-2与hs-CRP水平呈负相关(r=-0.385,P=0.003)。多因素logistic回归分析发现血浆高水平QKI、COX-2是冠心病患者PCI术后ISR的保护因素,高水平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COX-2的灵敏度为80.0%,特异度为70.7%;血浆QKI联合COX-2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COX-2的灵敏度为75.0%,特异度为70.6%;血浆QKI联合COX-2的灵敏度为81.7%,特异度为79.4%。血浆QKI联合COX-2预测冠心病患者PCI术后发生ISR及MACE的灵敏度、特异度均优于单独应用QKI或COX-2。结论: 高水平的血浆QKI和COX-2可能是冠心病患者PCI术后ISR的保护因素;血浆QKI和COX-2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。.