C反应蛋白水平对冠状动脉支架内再狭窄的预测价值

目的探讨血清C反应蛋白(CRP)与冠状动脉支架内再狭窄(ISR)发生的关系,旨在提高ISR患者临床检出率。方法选择2010年1月~2018年12月首都医科大学附属北京安贞医院急诊危重症中心收治的冠心病首次PCI患者3100例,PCI术后1年复查冠状动脉造影发现ISR患者430例(ISR组),未发现ISR患者2670例(无ISR组),比较2组一般临床资料及实验室化验指标,分析ISR发生的相关因素及与CRP的关系。结果ISR组出院时及随访时CRP水平明显高于无ISR组17.1(1.1,26.9)mg/L vs 12.9(0.9,23.5)mg/L,P=0.034;15.2(0.7,23.9)mg/L vs 3.9(0.2,7.9)mg/L,P=0.001]。逐步多元回归分析显示,ST段抬高型心肌梗死、出院时及随访时血清CRP水平是预测冠心病支架置入术后ISR的危险因素(P<0.05,P<0.01)。随访时CRP的ROC曲线下面积为0.861(95%CI:0.815~0.907,P<0.01),截点值12.23 mg/L,敏感性80.5%,特异性77.9%;出院时CRP的ROC曲线下面积为0.637(95%CI:0.566~0.709,P<0.01)。结论冠状动脉ISR发生与出院时及随访时CRP水平密切相关,应用随访时CRP水平对ISR进行预测具有较高的敏感性和特异性。

Value of serum CRP level in predicting coronary instent restenosis

Objective To improve the detection rate of coronary ISR in CHD patients by studying the relationship between serum CRP level and ISR.Methods A total of 3100 CHD patients who underwent first-ever PCI were divided into ISR group(n=430)and ISR-free group(n=2670).Their general clinical data and laboratory test parameters were compared.The ISR-related factors and their relationship with serum CRP level were analyzed in CHD patients.Results The serum CRP level was significantly higher in ISR group than in ISR-free group at discharge and during the follow-up period17.1(1.1,26.9)mg/L vs 12.9(0.9,23.5)mg/L,P=0.034;15.2(0.7,23.9)mg/L vs 3.9(0.2,7.9)mg/L,P=0.001].Multivariate regression analysis showed that STsegment elevation myocardial infarction and serum CRP level were the risk factors for ISR at discharge and during the follow-up period of CHD patients after stenting(P<0.05,P<0.01).The area under the ROC curve for CRP during the follow-up period of CHD patients was 0.861(95%CI:0.815-0.907,P<0.01)with a cut-off value of 12.23 mg/L,a sensitivity of 80.5%and a specificity of 77.9%.The area under the ROC curve for CRP at discharge of CHD patients was 0.637(95%CI:0.566-0.709,P<0.01).Conclusion Coronary ISR is closely related with serum CRP level in CHD patients at discharge and during the follow-up period.The sensitivity and specificity of serum CRP level are high for predicting ISR in CHD patients during the follow-up period.