术前sCD_(40)L预测冠状动脉支架后再狭窄的临床价值研究

目的:探讨冠状动脉粥样硬化性心脏病患者支架植入术前sCD40L对再狭窄的诊断预测价值。方法:选择成功接受普通支架置入术的稳定型心绞痛和不稳定型心绞痛患者共92例,分别于支架术前,术后1,5,15d和180d取外周静脉血测定血清sCD40L。所有患者随访6个月。结果:支架内再狭窄率23.9%(22/92)。再狭窄患者支架术前和术后血清sCD40L水平均显著高于无再狭窄患者(P均<0.01);再狭窄患者支架术后高水平sCD40L持续至术后6个月,而无再狭窄患者术后5d则恢复至正常。根据受试者工作特征曲线确定术前血清sCD40L>3.96μg/L为截断值,计算术前sCD40L诊断再狭窄的敏感性、特异性、阳性预测值、阴性预测值、准确度和阳性似然比分别为72.7%、90%、69.6%、91.3%、85.9%和7.27。多变量Logistic回归分析发现,在校正混杂因素后,术前sCD40L是术后再狭窄独立预测因子,OR=1.92(95%CI=1.39～2.64,P=0.013)。结论:再狭窄患者支架术前、术后血清sCD40L水平增加提示sCD40L可能与支架内再狭窄有关。支架术前血清sCD40L是术后再狭窄的独立预测因子,术前sCD40L有可能用于临床支架放置前危险分层的评价。

Clinical Value of Preprocedural Soluble CD_(40)L Ligand for Predicting Restenosis after Coronary Stent Implantation in Patients with Coronary Heart Disease

Objective:To investigate the predictive value of preprocedural soluble sCD40L ligand for in-stent restenosis after coronary stent implantation in patients with coronary heart disease.Methods:We enrolled 92 patients with stable angina and unstable angina who underwent successful stent implantation,Serum sCD40L was measured before and 1,5,15,and 180 days after stent implantation.The patient follow-up was 6 months.Results:Angiographically proven in-stent restenosis occurred in 22 patients(23.9%).Restenotic patients had preprocedural sCD40L and postprocedural sCD40L significantly higher than nonrestenotic patients(P<0.01).Enhanced sCD40L after stent implantation persisted as statically signifi cant throughout the study in the restenotic patients,whereas they normalized 5 days after the procedure in nonstenotic patients.According to receiver-operator characteristic analysis,sCD40L >3.96μg/L was determined as cut-off,and sensitivity,specifi city,and positive and negative predictive values,and accuracy and positive likelihood ratio of preprocedural sCD40L levels in-stent restenosis were 72.7%、90%、69.6%、91.3%、 85.9% and 7.27,respectively.At the multivariate logistic regression analysis,preprocedural sCD40L was an independent predictor(RR 1.92 95%CI 1.39～2.64,P=0.013) of stent restenosis after adjusting for confounding variables.Conclusion:Restenotic patients had signifi cantly higher preprocedural and postprocedural sCD40L,which suggests that sCD40L may be associated with in-stent restenosis.Increased preprocedural sCD40L level is an independent predictor of in-stent restenosis.We can use this marker for the assessment of risk stratifi cation before planning stent implantation.