D-二聚体、胱抑素C预测脑血管介入术后再狭窄的临床价值
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摘要
目的探究D-二聚体(D-D)、胱抑素C(CysC)预测脑血管介入术后再狭窄的临床价值。方法 2015年4月—2017年9月神经科收治的缺血性脑血管病患者共118例,均接受血管内支架植入术治疗,入院次日、术后3 d分别采集静脉血标本,测定血清D-D、CysC含量,并统计所有患者术后1年内再狭窄情况,将其分为再狭窄组、未狭窄组,分析血清D-D、CysC对术后再狭窄的预测能力。结果 118例患者术后1年内再狭窄16例,再狭窄率为13.56%。再狭窄组、未狭窄组术前基本资料及血清D-D、CysC水平差异无统计学意义(均P>0.05),术后3 d未狭窄组血清D-D、CysC水平未见明显变化(均P>0.05),而再狭窄组血清D-D、CysC水平明显升高(均P<0.05),且术后3 d血清D-D、CysC水平与未狭窄组相比显著升高(均P<0.05)。多因素Logistic回归分析发现术后3 d高D-D、CysC水平是术后再狭窄的独立危险因素(均P<0.05)。术后3 d血清D-D、CysC及二者联合预测术后再狭窄的受试者工作特征曲线(ROC)下面积分别为0.786、0.825、0.907,确定术后3 d血清D-D、CysC最佳临界值分别为356.22μg/L、1.41 mg/L,此时D-D、CysC联合预测术后再狭窄的灵敏度、特异度分别达87.50%、93.14%。结论脑血管介入术后高D-D、CysC水平是再狭窄的危险因素,对于术后再狭窄有较高的预测效能,密切监测血清D-D、CysC水平有助于评估再狭窄风险和及时制定个性化防治对策。
Objective To investigate the clinical value of D-dimer(D-D) and cystatin C(CysC) in predicting restenosis after cerebrovascular intervention. Methods Total 118 patients with ischemic cerebrovascular disease in our hospital from April 2015 to September 2017 were treated with endovascular stent implantation. Venous blood samples were collected on the day after admission and 3 days after surgery. Serum DD and CysC levels were measured, restenosis conditions of all patients within 1 year after operation were counted. They were divided into restenosis group and non-stenosis group. The predictive ability of postoperative restenosis with serum DD and CysC was analyzed. Results Of the 118 patients,there were 16 cases of restenosis within 1 year after operation, the restenosis rate was 13.56%. There were no significant differences in preoperative basic data and serum DD and CysC levels between the restenosis group and the non-stenosis group(all P>0.05). There was no significant change in serum DD and CysC levels in the non-stenosis group(all P>0.05), serum DD and CysC levels were significantly increased in the stenosis group(all P<0.05), serum DD and CysC levels were significantly higher than those in the non-stenosis group at 3 days after surgery(all P<0.05). Multivariate logistic regression analysis showed that high D-D and CysC levels were independent risk factors for postoperative restenosis(all P<0.05). The areas under the working characteristic curve(ROC) of predicting postoperative restenosis by serum DD, CysC and the combination of the two were 0.786, 0.825 and 0.907, respectively. The optimal cut-off value of serum DD and CysC were 356.22 μg/L, 1.41 mg/L, the sensitivity and specificity of predicting postoperative restenosis by the combination of DD and CysC were 87.50% and 93.14%, respectively. Conclusion High DD and CysC levels after cerebrovascular intervention are risk factors for restenosis. It has a high predictive effect on postoperative restenosis. Close monitoring of serum DD and CysC levels can help to assess the risk of restenosis and timely develop individualized prevention and treatment countermeasures.
Objective To investigate the clinical value of D-dimer(D-D) and cystatin C(CysC) in predicting restenosis after cerebrovascular intervention. Methods Total 118 patients with ischemic cerebrovascular disease in our hospital from April 2015 to September 2017 were treated with endovascular stent implantation. Venous blood samples were collected on the day after admission and 3 days after surgery. Serum DD and CysC levels were measured, restenosis conditions of all patients within 1 year after operation were counted. They were divided into restenosis group and non-stenosis group. The predictive ability of postoperative restenosis with serum DD and CysC was analyzed. Results Of the 118 patients,there were 16 cases of restenosis within 1 year after operation, the restenosis rate was 13.56%. There were no significant differences in preoperative basic data and serum DD and CysC levels between the restenosis group and the non-stenosis group(all P>0.05). There was no significant change in serum DD and CysC levels in the non-stenosis group(all P>0.05), serum DD and CysC levels were significantly increased in the stenosis group(all P<0.05), serum DD and CysC levels were significantly higher than those in the non-stenosis group at 3 days after surgery(all P<0.05). Multivariate logistic regression analysis showed that high D-D and CysC levels were independent risk factors for postoperative restenosis(all P<0.05). The areas under the working characteristic curve(ROC) of predicting postoperative restenosis by serum DD, CysC and the combination of the two were 0.786, 0.825 and 0.907, respectively. The optimal cut-off value of serum DD and CysC were 356.22 μg/L, 1.41 mg/L, the sensitivity and specificity of predicting postoperative restenosis by the combination of DD and CysC were 87.50% and 93.14%, respectively. Conclusion High DD and CysC levels after cerebrovascular intervention are risk factors for restenosis. It has a high predictive effect on postoperative restenosis. Close monitoring of serum DD and CysC levels can help to assess the risk of restenosis and timely develop individualized prevention and treatment countermeasures.
引文
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[15] 张琳,赵霞,殷颖.脑血管储备能力与中风的相关性分析[J].中国中西医结合影像学杂志,2016,14(4):483-484.
[16] 吴向军,王庆元,刘海涛,等.胱抑素C对兔血管成形术后再狭窄中血管外膜的影响[J].中华老年医学杂志,2015,34(4):441-445.
[17] 何姗姗,王晓燕,赵英帅,等.冠心病患者冠状动脉病变程度与血清胱抑素C及内皮功能相关性分析[J].重庆医学,2017,46(1):64-67.
[18] 杨天贵,付鹏,牛铁生.血清肌酐、胱抑素C及肾小球滤过率与支架内再狭窄的相关性[J].中国动脉硬化杂志,2017,25(8):818-822.
[19] LIND M,BOMAN K,JOHANSSON L,et al.D-dimer predicts major bleeding,cardiovascular events and all-cause mortality during warfarin treatment[J].Clin Biochem,2014,47(7):570-573.
[20] 曲明卫,吴慧君,张福波,等.脑梗死患者血清胱抑素C及D-二聚体与颈动脉斑块稳定性的关系[J].河北医科大学学报,2017,38(12):1369-1372.
[21] 李有中,郑重,谢康.动脉粥样硬化性脑梗死病人胱抑素C、同型半胱氨酸、超敏C反应蛋白和D-二聚体联合检测的临床意义[J].蚌埠医学院学报,2018,43(5):589-591.
[2] LAI S W,LIN H F,LIN C L,et al.Long-term effects of pioglitazone on first attack of ischemic cerebrovascular disease in older people with type 2 diabetes:a case-control study in Taiwan[J].Medicine,2016,95(31):e4455-e4456.
[3] GAO P,WANG D,ZHAO Z,et al.Multicenter prospective trial of stent placement in patients with symptomatic high-grade intracranial stenosis[J].AJNR Am J Neuroradiol,2016,37(7):1275-1280.
[4] GARCIA L A,ROCHA-SINGH K J,KRISHNAN P,et al.Angiographic classification of patterns of restenosis following femoropopliteal artery intervention:A proposed scoring system[J].Catheter Cardiovasc Interv,2017,90(4):639-646.
[5] WANG Y,HAFEEZ A,MENG F,et al.The correlation of D-dimer levels with patient outcomes in acute ischemic cerebrovascular disease complicating coronary heart disease[J].Neurol Res,2016,38(6):524-532.
[6] 陈向宇,葛良,黄显军,等.胱抑素C和尿蛋白对脑血管造影术后急性肾损伤的预测价值[J].皖南医学院学报,2016,35(2):126-129.
[7] 李红双,王琦.SWI在急性心源性脑血管栓塞中的应用价值[J].中国中西医结合影像学杂志,2018,16(4):341-343,355.
[8] 刘春红,刘颖.普罗布考联合瑞舒伐他汀对颅外脑血管支架植入术后再狭窄的影响[J].山东医药,2016,56(42):51-52.
[9] ARQUIZAN C,TRINQUART L,TOUBOUL P J,et al.Restenosis is more frequent after carotid stenting than after endarterectomy:the EVA-3S study[J].Stroke,2011,42(4):1015-1020.
[10] HEO S H,YOON K W,WOO S Y,et al.Comparison of early outcomes and restenosis rate between carotid endarterectomy and carotid artery stenting using propensity score matching analysis[J].Eur J Vasc Endovasc Surg,2017,54(5):573-578.
[11] 张红梅,杜大勇,石艳超,等.血清胱抑素C与缺血性卒中患者颅内外动脉狭窄的关系[J].滨州医学院学报,2017,40(3):195-197,203.
[12] LIU Y H,WANG Z P,LI J,et al.Inhibition of 5-Hydroxytryptamine receptor 2B reduced vascular restenosis and mitigated the β-Arrestin2-mammalian target of rapamycin/p70S6K pathway[J].J Am Heart Assoc,2018,7(3):e006810-e006819.
[13] ZHANG J B,JU X H,WANG J,et al.Serum cystatin C and cerebral microbleeds in patients with acute cerebral stroke[J].J Clin Neurosci,2014,21(2):268-273.
[14] 赵健斌,谭宁,刘勇,等.术前胱抑素C水平对冠脉介入术后急性肾损伤发生和远期不良预后的预测价值[J].实用医学杂志,2016,32(8):1254-1257.
[15] 张琳,赵霞,殷颖.脑血管储备能力与中风的相关性分析[J].中国中西医结合影像学杂志,2016,14(4):483-484.
[16] 吴向军,王庆元,刘海涛,等.胱抑素C对兔血管成形术后再狭窄中血管外膜的影响[J].中华老年医学杂志,2015,34(4):441-445.
[17] 何姗姗,王晓燕,赵英帅,等.冠心病患者冠状动脉病变程度与血清胱抑素C及内皮功能相关性分析[J].重庆医学,2017,46(1):64-67.
[18] 杨天贵,付鹏,牛铁生.血清肌酐、胱抑素C及肾小球滤过率与支架内再狭窄的相关性[J].中国动脉硬化杂志,2017,25(8):818-822.
[19] LIND M,BOMAN K,JOHANSSON L,et al.D-dimer predicts major bleeding,cardiovascular events and all-cause mortality during warfarin treatment[J].Clin Biochem,2014,47(7):570-573.
[20] 曲明卫,吴慧君,张福波,等.脑梗死患者血清胱抑素C及D-二聚体与颈动脉斑块稳定性的关系[J].河北医科大学学报,2017,38(12):1369-1372.
[21] 李有中,郑重,谢康.动脉粥样硬化性脑梗死病人胱抑素C、同型半胱氨酸、超敏C反应蛋白和D-二聚体联合检测的临床意义[J].蚌埠医学院学报,2018,43(5):589-591.
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