Zhou Q N, Lin W H, Jing R, Liu J J, Shi H Y, Yang R F, Gao P, Zhang Y
Clinical College of Cardiology, Tianjin Medial University and TEDA International Cardiovascular Hospital, Tianjin 300070, China.
Zhonghua Yi Xue Za Zhi. 2019 Dec 17;99(47):3732-3736. doi: 10.3760/cma.j.issn.0376-2491.2019.47.011.
To investigate the predictive value of epicardial adipose tissue volume (EATV) and inflammatory factors on in-stent restenosis (ISR) after percutaneous coronary implantation (PCI) in patients with coronary heart disease (CAD). A total of 407 patients with CAD who were treated with drug-eluting stents in TEDA international cardiovascular disease hospital were enrolled from November 2016 to October 2017. Levels of inflammatory cytokines such as high sensitive c-reactive protein (Hs-CRP), interleukin-6 (IL-6), and tumor necrosis factor (TNF-α) were detected. EATV was measured preoperatively by multi-sliced CT. Patients were divided into ISR group (52) and N-ISR group (355) according to ISR occurred within 1 year after procedure. The relationship between EATV and inflammatory factors and ISR after PCI was analyzed. The differences between ISR group (52) and N-ISR group (355) were statistically significant in terms of diabetes history, IL-6, TNF-α, EATV ((150±36) cm(3)vs(120±40) cm(3),0.001)), bifurcation lesions, stent length and Gensini score (<0.05). Multivariate Logistic regression analysis results showed that diabetes history,bifurcation lesions, TNF-α, EATV, and Gensini score were risk factors for in-stent restenosis.The area under the ROC curve (AUC) of EATV, TNF-α, and IL-6 in patients with CAD after PCI was 0.712, 0.752 and 0.675 (95 0.648-0.776, 0.686-0.819, 0.584-0.766, respectively, all <0.001), with a sensitivity of 86.5%, 67.3% and 69.2%, a specificity of 53.8%, 74.4% and 70.1% and a cut-off value of 116.61 cm(3),138.40 µg/L and 126.4 µg/L, respectively. EATV, TNF-α, and IL-6 have certain predictive values for in-stent restenosis, and can be used as clinical indicators to predict in-stent restenosis.
探讨冠心病（CAD）患者经皮冠状动脉介入治疗（PCI）后，心外膜脂肪组织体积（EATV）和炎症因子对支架内再狭窄（ISR）的预测价值。选取2016年11月至2017年10月在泰达国际心血管病医院接受药物洗脱支架治疗的407例CAD患者。检测高敏C反应蛋白（Hs-CRP）、白细胞介素-6（IL-6）和肿瘤坏死因子（TNF-α）等炎症细胞因子水平。术前通过多层CT测量EATV。根据术后1年内是否发生ISR将患者分为ISR组（52例）和非ISR组（355例）。分析PCI后EATV、炎症因子与ISR之间的关系。ISR组（52例）和非ISR组（355例）在糖尿病史、IL-6、TNF-α、EATV（（150±36）cm³对（120±40）cm³，P = 0.001）、分叉病变、支架长度和Gensini评分方面差异有统计学意义（P < 0.05）。多因素Logistic回归分析结果显示，糖尿病史、分叉病变、TNF-α、EATV和Gensini评分是支架内再狭窄的危险因素。PCI后CAD患者EATV、TNF-α和IL-6的ROC曲线下面积（AUC）分别为0.712、0.752和0.675（95%CI分别为0.648 - 0.776、0.686 - 0.819、0.584 - 0.766，均P < 0.001），灵敏度分别为86.5%、67.3%和69.2%，特异度分别为53.8%、74.4%和70.1%，截断值分别为116.61 cm³、138.40 μg/L和126.4 μg/L。EATV、TNF-α和IL-6对支架内再狭窄具有一定的预测价值，可作为预测支架内再狭窄的临床指标。
