缺血性脑卒中患者行颈动脉支架成形术前血清CCR5，SDF-1 mRNA 表达水平与术后支架内再狭窄的相关性研究

目的 分析术前血清趋化因子受体5(chemokine receptor 5，CCR5)、基质细胞衍生因子-1(stromal cellderivedfactor-1，SDF-1)表达水平与缺血性脑卒中(cerebral ischemic stroke, CIS)患者行颈动脉支架成形术(carotidartery stenting，CAS)后支架内再狭窄(in-stent restenosis，ISR)的关系。方法 选取廊坊市人民医院2019 年6 月～ 2021年1 月成功行CAS 的158 例缺血性脑卒中患者，收集患者临床资料，检测患者CAS 术前血清CCR5 和SDF-1 信使核糖核酸(messenger RNA，mRNA)表达水平，根据CAS 后一年有无ISR 将患者分为ISR 组(n=30)和非ISR 组(n=128)。比较ISR 组和非ISR 组临床资料、血清CCR5 和SDF-1 mRNA 表达水平；分析血清CCR5，SDF-1 mRNA 表达水平与管腔直径缩小率的相关性、缺血性脑卒中患者CAS 后发生ISR 的影响因素、血清CCR5，SDF-1 mRNA 表达水平对缺血性脑卒中患者CAS 后发生ISR 的预测价值。结果 ISR 组糖尿病比例(63.33% )、低密度脂蛋白胆固醇(lowdensity lipoprotein-cholesterol，LDL-C)水平(2.57±0.46 mmol/L)、血清CCR5(1.24±0.22)和SDF-1 mRNA(1.32±0.22)表达水平高于非ISR 组(42.97%，2.15±0.34 mmol/L，0.97±0.15，1.00±0.12)，差异均有统计学意义(χ2=4.048，t=5.668，8.233，10.786，均P ＜ 0.05)；血清CCR5 和SDF-1 mRNA 表达水平均与术后一年管腔直径缩小率呈正相关(r=0.516，0.583，P=0.014，0.008)；糖尿病、CCR5 和SDF-1 mRNA 是影响缺血性脑卒中患者行CAS 后发生ISR 的危险因素(Waldχ2=7.057，5.702，6.265，P=0.008，0.017，0.012)；血清CCR5 和SDF-1 mRNA 二者联合预测缺血性脑卒中患者CAS 后发生ISR 的曲线下面积分别为0.848，0.912，0.956；二者联合优于血清CCR5 和SDF-1 mRNA 单独预测(Z=2.192，2.494，P=0.028，0.013)。结论 术前血清CCR5 和SDF-1 mRNA 表达水平与缺血性脑卒中患者CAS后ISR 的发生密切相关，二者对ISR 的发生具有一定的预测效能。

Correlation between Serum CCR5, SDF-1 mRNA Expression Levels and Postoperative In-stent Restenosis in Patients with Ischemic Stroke before Carotid Artery Stenting

Objective To analyze the relationship between the expression levels of preoperative serum chemokine receptor 5 (CCR5), stromal cell-derived factor-1 (SDF-1) and in-stent restenosis (ISR) after carotid artery stenting (CAS) in patients with cerebral ischemic stroke (CIS). Methods 158 patients with cerebral ischemic stroke who successfully underwent CAS in Langfang People’s Hospital from June 2019 to January 2021 were selected. The clinical data were collected, the expression levels of serum CCR5 and SDF-1 messenger RNA (mRNA) were detected before CAS. According to the presence or absence of ISR one year after CAS, the patients were divided into ISR group (n=30 ) and non ISR group (n=128 ). The clinical data, the expression levels of serum CCR5 and SDF-1 mRNA in ISR group and non ISR group were compared. The correlation between the expression levels of serum CCR5 and SDF-1 mRNA and the reduction rate of lumen diameter, the influencing factors of ISR after CAS in patients with cerebral ischemic stroke, and the predictive value of the expression levels of serum CCR5 and SDF-1 mRNA for ISR after CAS in patients with cerebral ischemic stroke were analyzed. Results The proportion of diabetes (63.33%), LDL-C levels (2.57±0.46 mmol/L), serum CCR5 (1.24±0.22 ) and SDF-1 mRNA (1.32±0.22 ) expression levels in ISR group were higher than those in non ISR group (42.97%，2.15±0.34 mmol/L，0.97±0.15，1.00±0.12)，the differences were statistically significant(χ2=4.048，t=5.668，8.233，10.786，all P ＜ 0.05). The expression levels of serum CCR5 and SDF-1 mRNA were positively correlated with the reduction rate of lumen diameter one year after operation (r=0.516, 0.583, P=0.014, 0.008). Diabetes mellitus, CCR5, SDF-1 mRNA was a risk factor for ISR after CAS in patients with cerebral ischemic stroke (Waldχ2=7.057, 5.702, 6.265，P=0.008, 0.017, 0.012).The areas under curve of serum CCR5, SDF-1 mRNA and their combination in predicting ISR after CAS in patients with cerebral ischemic stroke were 0.848, 0.912 and 0.956 respectively, and the combination of the two was better than the prediction of serum CCR5 and SDF-1 mRNA alone (Z=2.192, 2.494, P=0.028, 0.013). Conclusion The expression levels of serum CCR5 and SDF-1 mRNA before operation were closely related to the occurrence of ISR after CAS in patients with cerebral ischemic stroke, and they have a certain predictive effect on the occurrence of ISR.