E-选择素水平的变化可预测颈动脉支架置入术后颈动脉狭窄的进展。

Changes in E-Selectin Levels Predict Carotid Stenosis Progression after Carotid Artery Stenting.

作者信息

Liu Chi-Hung, Lee Tsong-Hai, Chang Pi-Yueh, Chang Chien-Hung, Wu Hsiu-Chuan, Chang Ting-Yu, Huang Kuo-Lun, Cheng Chih-Kuang, Chang Yeu-Jhy

机构信息

Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Graduate Institute of Clinical Medical Sciences, Division of Medical Education, College of Medicine, Chang Gung University, Taoyuan, Taiwan.

出版信息

Curr Neurovasc Res. 2018;15(1):18-25. doi: 10.2174/1567202615666180319150021.

DOI:10.2174/1567202615666180319150021

PMID:29557748

Abstract

BACKGROUND

We hypothesized that the inflammatory markers (IM) could be the independent predictors of Carotid Stenosis Progression (CSP) after Carotid Artery Stenting (CAS).

METHODS

Between 2010 and 2012, 122 patients undergoing cervicocranial revascularization in our hospital were prospectively recruited. Patients undergoing revascularizations other than CAS were excluded. Carotid duplex ultrasonography was performed before and at 1 week, 6 months (6M), 1 year, and 2 years after CAS. IM levels were recorded before CAS and were followed up immediately and 6M after CAS. The data was analyzed retrospectively. Patients were categorized into the Progression Group (PG) and Nonprogression Group (NPG) based on the presence or absence of CSP, including in-stent restenosis (ISR) and worsening contralateral carotid stenosis. Receiver operating characteristic and multivariate logistic regression analyses were conducted.

RESULTS

In Total, 77 patients were enrolled. The frequency of CSP was 24.7% (ISR: 14.3%; worsening contralateral carotid stenosis: 14.3%). Compared with the NPG, the PG had lower E-selectin levels before CAS [PG vs. NPG, 47.90 (42.80, 64.90) vs. 68.25 (52.08, 92.30); p = .01] and a nonreduced E-selectin levels at 6M after CAS [PG vs. NPG, 7.65 (-2.45, 25.75) vs. -16.10 (-33.45, 1.65); p = .002]. The E-selectin changes between 6M after and before CAS had highest predictive accuracy on CSP (area under the curve = 0.74, p = .002). The optimal cut-off level was a 2.95 ng/mL decrease and the adjusted odds ratio for CSP was 10.16 (p = .001).

CONCLUSION

The E-selectin changes between 6M after and before CAS are independent predictors of CSP.

摘要

背景

我们假设炎症标志物（IM）可能是颈动脉支架置入术（CAS）后颈动脉狭窄进展（CSP）的独立预测因素。

方法

2010年至2012年期间，前瞻性招募了我院122例行颈颅血管重建术的患者。排除接受除CAS以外的血管重建术的患者。在CAS前以及CAS后1周、6个月（6M）、1年和2年进行颈动脉双功超声检查。记录CAS前的IM水平，并在CAS后立即和6M进行随访。对数据进行回顾性分析。根据是否存在CSP，包括支架内再狭窄（ISR）和对侧颈动脉狭窄加重，将患者分为进展组（PG）和非进展组（NPG）。进行了受试者操作特征和多变量逻辑回归分析。

结果

总共纳入77例患者。CSP的发生率为24.7%（ISR：14.3%；对侧颈动脉狭窄加重：14.3%）。与NPG相比，PG在CAS前的E选择素水平较低[PG与NPG，47.90（42.80，64.90）对68.25（52.08，92.30）；p = 0.01]，且在CAS后6M时E选择素水平未降低[PG与NPG，7.65（-2.45，25.75）对-16.10（-33.45，1.65）；p = 0.002]。CAS后6M与CAS前之间的E选择素变化对CSP具有最高的预测准确性（曲线下面积 = 0.74，p = 0.002）。最佳截断水平为降低2.95 ng/mL，CSP的调整优势比为10.16（p = 0.001）。