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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。
Objective: To investigate the predictive value of sCD40L in the diagnosis of restenosis in patients with coronary atherosclerotic heart disease before stent implantation. Methods: A total of 92 patients with stable angina pectoris and unstable angina pectoris selected for successful stenting were enrolled in this study. Peripheral venous blood was collected before surgery and at 1, 5, 15 and 180 days after operation for determination of serum sCD40L. All patients were followed up for 6 months. Results: The rate of in-stent restenosis was 23.9% (22/92). The levels of sCD40L in patients with restenosis were significantly higher than those without restenosis (P <0.01). The sCD40L level in patients with restenosis was elevated to 6 months after stenting and no restenosis After 5d return to normal. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and positive likelihood ratio of preoperative sCD40L in the diagnosis of stenosis were calculated according to the working curve of the subjects, the preoperative sCD40L> 3.96μg / L was determined as the cutoff value Respectively 72.7%, 90%, 69.6%, 91.3%, 85.9% and 7.27. Multivariate logistic regression analysis showed that preoperative sCD40L was an independent predictor of postoperative restenosis after correction for confounding factors, OR = 1.92 (95% CI = 1.39-2.64, P = 0.013). Conclusion: The increase of serum sCD40L levels in patients with restenosis before and after stenting suggests that sCD40L 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.