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中华损伤与修复杂志(电子版) ›› 2017, Vol. 12 ›› Issue (06) : 447 -453. doi: 10.3877/cma.j.issn.1673-9450.2017.06.009

所属专题： 文献；

论著

高龄陈旧性心肌梗死患者冠状动脉支架置入术后再狭窄的新型诊断标志物的研究
张丽1, 刘涛2, 蒋长兴2, 胡有东1, 张枫林1, 陈颖1, 周华兰1, 郭殿选1, 赵庆娜1, 李侠1,†()   
  1. 1. 223002　徐州医科大学附属淮安医院老年病科
    2. 223003　淮安，淮阴工学院
  • 收稿日期:2017-10-25 出版日期:2017-12-01
  • 通信作者: 李侠
  • 基金资助:
    国家自然科学基金(31500778，31170916); 江苏省高校自然科学研究计划项目(KJD310234); 江苏省卫生国际交流支撑计划项目(JSWSGJ2012366)

Research on the new diagnostic marker of restenosis after coronary stent implantation in elderly patients with old myocardial infarction

Li Zhang1, Tao Liu2, Changxing Jiang2, Youdong Hu1, Fenglin Zhang1, Ying Chen1, Hualan Zhou1, Dianxuan Guo1, Qingna Zhao1, Xia Li1,†()   

  1. 1. Department of Geriatrics, Huai′an Hospital Affiliated of Xuzhou Medical University, Huai′an 223002, China
    2. Huaiyin Institute of Technology, Huai′an 223003, China
  • Received:2017-10-25 Published:2017-12-01
  • Corresponding author: Xia Li
  • About author:
    Corresponding author: Li Xia, Email:
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引用本文：

张丽, 刘涛, 蒋长兴, 胡有东, 张枫林, 陈颖, 周华兰, 郭殿选, 赵庆娜, 李侠. 高龄陈旧性心肌梗死患者冠状动脉支架置入术后再狭窄的新型诊断标志物的研究[J]. 中华损伤与修复杂志(电子版), 2017, 12(06): 447-453.

Li Zhang, Tao Liu, Changxing Jiang, Youdong Hu, Fenglin Zhang, Ying Chen, Hualan Zhou, Dianxuan Guo, Qingna Zhao, Xia Li. Research on the new diagnostic marker of restenosis after coronary stent implantation in elderly patients with old myocardial infarction[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2017, 12(06): 447-453.

目的

研究外周血内皮祖细胞(EPC)、基质细胞衍生因子-1α (SDF-1α)、血管内皮生长因子(VEGF)和一氧化氮(NO)水平变化对高龄陈旧性心肌梗死患者冠状动脉支架置入术后再狭窄的诊断预测。

方法

选择2007年1月至2016年9月徐州医科大学附属淮安医院高龄陈旧性心肌梗死冠状动脉支架置入术后再狭窄患者51例，设为观察组；同时选择冠状动脉造影提示冠脉内膜欠光滑，但无明显狭窄缺损表现的患者30例，设为对照组。观察组患者按照冠状动脉再狭窄支数、冠状动脉再狭窄程度、左室射血分数(LVEF)和美国纽约心脏病学会(NYHA)心功能分级再进行分组。测定所有患者循环EPC、SDF-1α、VEGF和NO的水平变化。数据比较采用单因素方差分析和LSD法。

结果

(1)随着冠状动脉再狭窄支数的增加，EPC、SDF-1α、VEGF和NO水平均降低，差异均有统计学意义(F＝140.0、122.8、183.8、515.8，P值均小于0.05)。多支再狭窄组患者EPC、SDF-1α、VEGF和NO水平均低于对照组、单支再狭窄组、双支再狭窄组，差异均有统计学意义(P值均小于0.05)。(2)随着冠状动脉再狭窄程度加重，EPC、SDF-1α、VEGF和NO水平降低，差异均有统计学意义(F＝120.7、124.9、107.5、127.1，P值均小于0.05)；冠状动脉再狭窄100%组患者EPC、SDF-1α、VEGF和NO水平分别为(0.3±0.2)%、(3.3±1.3) ng/L、(1.1±0.8) ng/L、(15.1±10.8)μmol/L，低于冠状动脉再狭窄90%～99%组[(1.1±0.4)%、(5.3±2.7) ng/L、(2.0±0.5) ng/L、(27.8±12.9) μmol/L]，差异均有统计学意义(P值均小于0.05)；冠状动脉再狭窄100%组患者EPC、SDF-1α、VEGF和NO水平均低于对照组与70%～89%组，差异均有统计学意义(P值均小于0.05)。(3)随着LVEF下降，EPC、SDF-1α、VEGF和NO水平降低，差异均有统计学意义(F＝663.0、1599.0、720.0、2188.4，P值均小于0.05)；25%～36%组患者EPC、SDF-1α、VEGF和NO水平显著低于其他各组，差异均有统计学意义(P值均小于0.05)。(4)随着NYHA级别的增高，EPC、SDF-1α、VEGF和NO水平下降，差异均有统计学意义(F＝135.1、118.2、175.6、115.2，P值均小于0.05)；NYHA Ⅳ级组患者EPC、SDF-1α、VEGF和NO水平显著低于其他各组，差异均有统计学意义(P值均小于0.05)。

结论

EPC、SDF-1α、VEGF和NO可以作为高龄陈旧性心肌梗死冠状动脉支架置入术后再狭窄的新型诊断标志物。

关键词: 冠状动脉再狭窄, 冠状动脉闭塞, 支架, 心肌梗塞, 诊断, 老年人, 标志物
Objective

To study the value of circulating endothelial progenitor cell(EPC), stromal cell-derived factor-1α(SDF-1α), vascular endothelial growth factor(VEGF) and nitric oxide(NO) in diagnosis and prediction of in-stent restenosis after primary coronary intervention in elderly patients with old myocardial infarction.

Methods

Fifty-one elderly patients with restenosis after coronary sent implantation in Huai′an Hospital Affiliated of Xuzhou Medical University after primary coronary intervention from Jan.2007 to Sep.2016 were selected as observation group, 30 cases with the roughness of coronary vessels and without restenosis based on the analysis of coronary arteriography were considered as the control group. The patients in observation group were divided into different groups according to restenosis of vessels, severity of vessel restenosis, left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) . The levels of EPC, SDF-1α, VEGFand NO were measured in the patients. The data were compared by one-way ANOVA and LSD test.

Results

(1) The 1evels of EPC, SDF-1α, VEGF and NO were decreased along with the increase in the number of restenosis of vessels in elderly patients with old myocardial infarction, the differences were statistically significant(F=140.0, 122.8, 183.8, 515.8; with P values below 0.05). The levels of EPC, SDF-1α, VEGF and NO in patients with multivessel restenosis were lower than that in control group, a single vessel restenosis group and double vessel restenosis group, the differences were statistically significant(with P values below 0.05). (2)Along with severity of vessel restenosis, the levels of EPC, SDF-1α, VEGF and NO were decreased, the differences were statistically significant(F=120.7, 124.9, 107.5, 127.1; with P values below 0.05). The levels of EPC, SDF-1α, VEGF and NO in patients with in-stent restenosis (100%) were (0.3±0.2)%, (3.3±1.3) ng/L, (1.1±0.8) ng/L, (15.1±10.8) μmol/L, lower than that in patients with in-stent restenosis (90%-99%)[(1.1±0.4)%, (5.3±2.7) ng/L, (2.0±0.5) ng/L, (27.8±12.9) μmol/L], the differences were statistically significant(with P values below 0.05). The levels of EPC, SDF-1α, VEGF and NO in patients with in-stent restenosis (100%) were lower than in patients with in-stent restenosis (70%-89%) and the control group, the differences were statistically significant(with P values below 0.05). (3) With the decrease of LVEF, the levels of EPC, SDF-1α, VEGF and NO were decreased, the differences were statistically significant(F=663.0, 1599.0, 720.0, 2188.4; with P values below 0.05). The levels of EPC, SDF-1α, VEGF and NO in the LVEF 25%-36% group were lower than other groups significantly, the differences were statistically significant(with P values below 0.05). (4) Along with the decrease of NYHA, the levels of EPC, SDF-1α, VEGF and NO were decreased, the differences were statistically significant(F=135.1, 118.2, 175.6, 115.2; with P values below 0.05). The levels of EPC, SDF-1α, VEGF and NO in the patients with NYHA Ⅳ group were lower than other groups significantly, the differences were statistically significant(with P values below 0.05).

Conclusion

EPC, SDF-1α, VEGF and NO may be used as the new diagnostic makers for restenosis after primary coronary stent implantation in elderly patients with old myocardial infarction.

Key words: Coronary restenosis, Coronary occlusion, Stents, Myocardial infarction, Diagnosis, Aged, Marker
表1 冠状动脉再狭窄的高龄陈旧性心肌梗死患者根据冠状动脉再狭窄支数分组情况及比较
组别 例数 性别(例) 年龄(岁，±s) 病程(年，±s)
男 女
单支再狭窄组 25 16 9 76.5±5.7 5.9±0.7
双支再狭窄组 16 9 7 75.9±4.3 6.1±0.9
多支再狭窄组 10 7 3 78.2±6.9 7.0±0.6
表2 冠状动脉再狭窄的高龄陈旧性心肌梗死患者根据冠状动脉再狭窄程度不同分组情况及比较
组别 例数 性别(例) 年龄(岁，±s) 病程(年，±s)
男 女
70%～89%组 25 15 10 76.8±4.9 5.9±0.7
90%～99%组 15 9 6 78.5±5.1 6.1±0.9
100%组 11 7 4 81.0±6.0 7.0±0.6
表3 冠状动脉再狭窄的高龄陈旧性心肌梗死患者根据LVEF不同分组情况及比较
组别 例数 性别(例) 年龄(岁，±s) 病程(年，±s)
男 女
LVEF 49%～59%组 29 19 10 82.0±5.4 5.9±0.7
LVEF 37%～48%组 14 9 5 79.0±5.9 6.1±0.9
LVEF 25%～36%组 8 5 3 82.0±4.9 7.0±0.6
表4 冠状动脉再狭窄的高龄陈旧性心肌梗死患者根据NYHA不同分级分组情况及比较
组别 例数 性别(例) 年龄(岁，±s) 病程(年，±s)
男 女
NYHA Ⅰ级组 21 18 3 77.0±4.7 6.0±0.1
NYHA Ⅱ级组 13 8 5 76.0±5.1 5.9±0.7
NYHA Ⅲ级组 10 6 4 77.0±5.7 6.1±0.9
NYHA Ⅳ级组 7 5 2 80.0±4.9 7.0±0.6
表5 不同冠状动脉再狭窄支数组高龄陈旧性心肌梗死患者与冠状动脉内膜欠光滑对照组患者EPC、SDF-1α、VEGF和NO水平变化(±s)
组别 例数 EPC(%) SDF-1α(ng/L) VEGF(ng/L) NO(μmol/L)
对照组 30 4.1±0.6 8.9±3.1 4.4±1.7 69.2±15.4
单支再狭窄组 25 2.0±0.4a 7.0±3.9a 3.1±1.5a 50.1±16.0a
双支再狭窄组 16 1.3±0.2ab 4.4±2.7ab 1.9±0.8ab 32.6±15.9ab
多支再狭窄组 10 0.6±0.1abc 1.0±0.8abc 1.1±0.9abc 18.2±13.7abc
F值 ? 140.08 122.84 183.81 515.83
P值 ? 0.007 0.008 0.005 0.002
表6 不同程度冠状动脉再狭窄组高龄陈旧性心肌梗死患者与冠状动脉内膜欠光滑对照组患者EPC、SDF-1α、VEGF和NO水平变化(±s)
组别 例数 EPC(%) SDF-1α(ng/L) VEGF(ng/L) NO(μmol/L)
对照组 30 4.3±0.7 9.3±3.7 5.0±1.1 67.6±13.9
70%～89%组 25 3.7±0.5a 8.0±3.2a 3.9±1.5a 45.1±14.1a
90%～99%组 15 1.1±0.4ab 5.3±2.7ab 2.0±0.5ab 27.8±12.9ab
100%组 11 0.3±0.2abc 3.3±1.3abc 1.1±0.8abc 15.1±10.8abc
F值 ? 120.71 124.92 107.53 127.14
P值 ? 0.008 0.008 0.009 0.008
表7 LVEF各组高龄陈旧性心肌梗死患者与冠状动脉内膜欠光滑对照组患者EPC、SDF-1α、VEGF和NO水平变化(±s)
组别 例数 EPC(%) SDF-1α(ng/L) VEGF(ng/L) NO(μmol/L)
对照组 30 4.3±0.7 9.3±3.7 5.0±1.1 67.6±13.9
LVEF 49%～59%组 29 4.9±0.5 9.9±4.5 5.9±1.7 70.0±12.7
LVEF 37%～48%组 14 2.5±0.9a 6.3±2.8a 3.4±0.9a 48.9±13.0a
LVEF 25%～36%组 8 0.2±0.1ab 2.6±1.7ab 1.0±0.6ab 27.3±11.9ab
F值 ? 663.00 1599.00 720.00 2188.41
P值 ? 0.008 0.005 0.008 0.004
表8 NYHA各级别高龄陈旧性心肌梗死患者与冠状动脉内膜欠光滑对照组患者组EPC、SDF-1α、VEGF和NO水平变化(±s)
组别 例数 EPC(%) SDF-1α(ng/L) VEGF(ng/L) NO(μmol/L)
对照组 30 4.3±0.7 9.3±3.7 5.0±1.1 67.6±13.9
NYHA Ⅰ级组 21 4.1±0.9 9.9±3.5 6.0±1.9 69.1±14.9
NYHA Ⅱ级组 13 3.2±0.8 8.0±3.7 4.9±1.1 58.9±14.6
NYHA Ⅲ级组 10 1.8±0.4a 6.1±2.0a 3.4±0.7a 40.9±12.9a
NYHA Ⅳ级组 7 0.2±0.1ab 3.0±1.6ab 1.6±0.5ab 19.0±10.8ab
F值 ? 135.12 118.23 175.61 115.20
P值 ? 0.007 0.008 0.006 0.009
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