血浆中C反应蛋白和白细胞介素-10的水平可预测择期支架置入术后6个月冠状动脉支架内晚期再狭窄情况。

Plasma levels of C-reactive protein and interleukin-10 predict late coronary in-stent restenosis 6 months after elective stenting.

作者信息

Zurakowski Aleksander, Wojakowski Wojciech, Dzielski Tadeusz, Milewski Krzysztof, Gościńska-Bis Kinga, Tendera Michał, Buszman Paweł

机构信息

III Klinika Kardiologii, Slaski Uniwersytet Medyczny, Górnoślaski Ośrodek Kardiologii, ul. Ziołowa 47, 40-635 Katowice, Poland.

出版信息

Kardiol Pol. 2009 Jun;67(6):623-30.

PMID:19618318

Abstract

BACKGROUND

In-stent restenosis (ISR) is one of the major limitations of percutaneous coronary intervention (PCI).

AIM

To evaluate the relationship between the levels of hs-CRP, IL-6, IL-10 and intimal hyperplasia six months after coronary bare metal stent (BMS) implantation.

METHODS

The study population consisted of 73 consecutive patients who underwent bare metal stent implantation into narrowed coronary segments. A total of 74 stents were implanted. Angiographic study after six months, together with evaluation of serum level of IL-6 (pg/ml), IL-10 (pg/ml), hs-CRP (microg/ml), fasting insulin (microIU/ml) and glucose (mg%) was performed. Insulin sensitivity was calculated using the HOMA-IR formula. The QCA analysis of stented segments was performed at baseline, after intervention and at six-month follow-up.

RESULTS

Restenosis at six months occurred in 10 patients (13.7%). The mean % diameter stenosis at follow-up was 27.8 +/- 19% and late loss was 0.81 +/- 0.6 mm. We found a correlation between late loss and serum hs-CRP, IL-6 and IL-10 concentration. There was no correlation between the lipid profiles, insulin levels and HOMA-IR and re-narrowing of the stented segments. Patients with restenosis were characterised by significantly higher serum concentration of CRP (2.04 +/- 3.4 vs. 10.38 +/- 6.7 microg/ml, p = 0.0036), IL-6 (14.98 +/- 8.3 vs. 5.70 +/- 5.5 pg/ml, p = 00062), and fasting glucose (184.0 +/- 50.5 vs. 107.5 +/- 40.4 mg%, p = 0.0051), as well as lower IL-10 levels (1.25 +/- 0.6 vs. 4.85 +/- 4.9 pg/ml, p = 0.0000). The ROC analysis indicated that CRP (> 2.86 microg/ml), IL-6 (> 6.24 pg/ml) and IL-10 (< 1.7 pg/ml) values predicted the restenosis with reasonable accuracy. A multiple logistic regression model identified CRP and IL-10 levels as independent predictors of restenosis.

CONCLUSION

We demonstrated that elevated inflammatory markers 6 months after PCI are associated with late angiographic in-stent restenosis.

摘要

背景

支架内再狭窄（ISR）是经皮冠状动脉介入治疗（PCI）的主要局限性之一。

目的

评估冠状动脉裸金属支架（BMS）植入6个月后hs-CRP、IL-6、IL-10水平与内膜增生之间的关系。

方法

研究人群包括73例连续患者，这些患者在狭窄的冠状动脉节段植入了裸金属支架。共植入74枚支架。6个月后进行血管造影研究，并评估血清IL-6（pg/ml）、IL-10（pg/ml）、hs-CRP（μg/ml）、空腹胰岛素（μIU/ml）和葡萄糖（mg%）水平。使用HOMA-IR公式计算胰岛素敏感性。在基线、干预后和6个月随访时对植入支架的节段进行QCA分析。

结果

10例患者（13.7%）在6个月时发生再狭窄。随访时平均直径狭窄百分比为27.8±19%，晚期管腔丢失为0.81±0.6mm。我们发现晚期管腔丢失与血清hs-CRP、IL-6和IL-10浓度之间存在相关性。血脂谱、胰岛素水平和HOMA-IR与植入支架节段的再狭窄之间无相关性。再狭窄患者的特征是血清CRP浓度显著升高（2.04±3.4 vs. 10.38±6.7μg/ml，p = 0.0036）、IL-6（14.98±8.3 vs. 5.70±5.5 pg/ml，p = 0.0062）和空腹血糖（184.0±50.5 vs. 107.5±40.4 mg%，p = 0.0051），以及较低的IL-10水平（1.25±0.6 vs. 4.85±4.9 pg/ml，p = 0.0000）。ROC分析表明，CRP（> 2.86μg/ml）、IL-6（> 6.24 pg/ml）和IL-10（< 1.7 pg/ml）值能以合理的准确性预测再狭窄。多元逻辑回归模型确定CRP和IL-10水平是再狭窄的独立预测因素。