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目的探讨冠心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,术后第1、5、15天和180天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浓度均显著高于无再狭窄患者术前sCD40L浓度;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5天恢复至正常。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(PPV)、阴性预测值(NPV)、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,OR1.92(95%CI1.39～2.64,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。
Objective To investigate the predictive value of sCD40L in the diagnosis of restenosis before stent implantation in patients with coronary heart disease. Methods A total of 92 patients with stable angina pectoris and unstable angina who underwent stenting were selected. Serum sCD40L was measured in peripheral venous blood before surgery, on day 1, 5, 15, and 180 after operation. All patients were followed up for 6 months. Results The rate of in-stent restenosis was 23.9% (22/92). The sCD40L concentrations in preoperative and postoperative restenosis patients were significantly higher than those in patients without restenosis. The sCD40L level in patients with restenosis was elevated to 6 months postoperatively, while those with no restenosis 5 days postoperatively Days returned to normal. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of preoperative sCD40L for the diagnosis of stenosis were calculated according to the working curve of the subjects, and the preoperative sCD40L> 3.96μg / L was determined as the cutoff value. The degrees and positive likelihood ratios were 72.7%, 90%, 69.6%, 91.3%, 85.9% and 7.27, respectively. Multivariate Logistic regression analysis showed that preoperative sCD40L was an independent predictor of postoperative restenosis after correction of confounding factors, OR1.92 (95% CI 1.39-2.64, P = 0.013). Conclusion The increase of serum sCD40L levels in patients with restenosis before and after stenting may be related to in-stent restenosis. Preoperative serum sCD40L is an independent predictor of postoperative restenosis, preoperative sCD40L may be used for the evaluation of risk stratification before placement of the stent.