Ang-2/Ang-1比值对稳定型心绞痛患者择期行经皮冠状动脉介入后发生围术期心肌梗死的预测价值

Value of Ang-2/Ang-1 level in predicting perioperative myocardial infarction in patients with stable angina pectoris undergoing elective PCI

摘要:

目的 探讨血管生成素-2（Ang-2）/血管生成素-1（Ang-1）比值对稳定型心绞痛（SAP）患者择期行经皮冠状动脉介入（PCI）后发生围术期心肌梗死（PMI）的预测价值。方法 选取2017年5月—2018年3月大庆油田总医院接受PCI治疗的98例SAP患者为研究对象，根据患者PCI后是否发生PMI分为PMI组（30例）和SAP组（68例），同时选取同期该院健康体检志愿者36例为对照组。采用ELISA法检测血清Ang-2、Ang-1水平，并计算Ang-2/Ang-1比值；ELISA法检测PMI患者血清白细胞介素-4（IL-4）、白细胞介素-10（IL-10）、白细胞介素-8（IL-8）、肌钙蛋白T（cTnT）、肌酸激酶同工酶（CK-MB）水平。Pearson法分析Ang-2/Ang-1比值与PMI患者血清指标的相关性；采用受试者工作特征（ROC）曲线分析Ang-2/Ang-1比值对PMI的诊断价值。结果 PMI组与SAP组血清Ang-2水平及Ang-2/Ang-1比值均高于对照组（P?<0.05），且PMI组高于SAP组（P?<0.05）；血清Ang-1水平低于对照组（P?<0.05），且PMI组低于SAP组（P?<0.05）；PMI组患者血清IL-4、IL-18、CK-MB、cTnT水平均高于SAP组（P?<0.05），而IL-10水平低于SAP组（P?<0.05）；Ang-2/Ang-1比值与IL-4（r?=0.443，P?<0.05）、IL-18（r?=0.248，P?< 0.05）、CK-MB（r?=0.562，P?<0.05）和cTnT（r?=0.312，P?<0.05）均呈正相关；双支病变PMI患者血清Ang-1水平低于单支病变、多支病变（P?<0.05），且多支病变低于单支病变（P?<0.05），血清Ang-2水平与Ang-2/ Ang-1比值均高于单支病变、多支病变（P?<0.05），且多支病变高于单支病变（P?<0.05）；Ang-2/Ang-1比值对PMI的诊断价值，截断值为1.57，ROC曲线下面积（AUC）为0.885（95% CI：0.805，0.941），敏感性为86.67%（95% CI：0.684，0.956），特异性为97.06%（95% CI：0.888，0.995）。结论 PMI患者血清Ang-2水平与Ang-2/Ang-1比值升高，而血清Ang-1水平降低，其均可参与PMI发生过程，Ang-2/Ang-1比值对SAP患者PCI术后PMI的发生具有较高的预测价值。

Abstract:

Objective To investigate the predictive value of the ratio of angiopoietin-2 (Ang-2) to angiopoietin-1 (Ang-1) in the occurrence of perioperative myocardial infarction (PMI) in patients with stable angina pectoris (SAP) undergoing selective percutaneous coronary intervention (PCI). Methods Totally 98 patients with stable angina pectoris treated by PCI in our hospital from May 2017 to March 2018 were selected as the subjects and divided into PMI group (30 cases) and SAP group (68 cases) according to the occurrence of myocardial infarction after PCI. At the same time, another 36 healthy volunteers in our hospital during the same period were selected as the control group. Serum Ang-2 and Ang-1 levels were detected by ELISA, Ang-2/Ang-1 value was calculated; the levels of serum interleukin-4 (IL-4), interleukin-10 (IL-10), interleukin-8 (IL-8), troponin T (cTnT), and creatine kinase isoenzyme (CK-MB) were measured by ELISA. Pearson method was used to analyze the correlation between Ang-2/Ang-1 value with serum parameters of PMI patients; the diagnostic value of Ang-2/Ang-1 value in PMI was analyzed by ROC. Results Serum Ang-2 level and Ang-2/Ang-1 ratio in PMI group and SAP group were higher than those in control group (P?< 0.05), and PMI group was higher than SAP group (P?