GDF-15、VEGF、CXCR4与冠心病PCI术后支架再狭窄的关系

Relationship between GDF-15, VEGF, CXCR4 and Stent Restenosis after PCI in Coronary Heart Disease

摘要

目的 探讨生长分化因子-15（GDF-15）、血管内皮生长因子（VEGF）、CXC族趋化因子受体4（CXCR4）水平与冠心病患者经皮冠状动脉介入术（PCI）术后支架再狭窄（ISR）的关系。方法 选取2021年3月~2022年6月河南省荣军医院收治的118例冠心病患者,均接受PCI,根据PCI术后是否发生ISR分为ISR组（n=24例）和非ISR组（n=94例）,采用酶联免疫吸附法测定GDF-15、CXCR4,双抗体夹心-酶联免疫吸附法测定VEGF,分析血清GDF-15、VEGF、CXCR4与冠心病患者PCI术后ISR的相关性及预测价值。结果 ISR组冠脉病变支数、植入支架数量多于非ISR组,冠脉病变长度长于非ISR组,术前Gensini积分、左室射血分数（LVEF）、D-二聚体（D-D）、纤维蛋白原（FIB）、GDF-15、VEGF高于非ISR组,CXCR4低于非ISR组,差异具有统计学意义（P<0.05）。FIB、GDF-15、VEGF水平升高和CXCR4水平下降是PCI术后发生ISR的独立危险因素,差异具有统计学意义（P<0.05）;进一步校正FIB影响后,GDF-15、VEGF、CXCR4仍与PCI术后ISR发生有关。血清GDF-15、VEGF、CXCR4联合预测PCI术后ISR的AUC明显大于各指标单一预测,差异具有统计学意义（P<0.05）。结论 血清GDF-15、VEGF、CXCR4水平与冠心病患者PCI术后ISR具有显著相关性,三者均对ISR具有预测价值,联合检测能为临床提供更为可靠的数据支持。

Abstract

Objective To investigate the relationship between the levels of growth differentiation factor-15 (GDF-15), vascular endothelial growth factor (VEGF), and CXC chemokine receptor 4 (CXCR4) and in-stent restenosis (ISR) in patients with coronary heart disease after percutaneous coronary intervention (PCI). Methods A total of 118 patients with coronary heart disease admitted to Henan Provincial Rongjun Hospital from March 2021 to June 2022 were selected and all received PCI. They were divided into ISR group (24 cases) and non-ISR group (94 cases) according to whether ISR occurred after PCI. Enzyme-linked immunosorbent assay was used to measure GDF-15 and CXCR4, and double antibody sandwich-enzyme-linked immunosorbent assay was used to measure VEGF. The correlation and predictive value of serum GDF-15, VEGF, CXCR4 and ISR in patients with coronary heart disease after PCI were analyzed. Results The number of coronary lesions and the number of stents implanted in the ISR group were higher than those in the non-ISR group, and the length of coronary lesions was longer than that in the non-ISR group. The preoperative Gensini score, left ventricular ejection fraction (LVEF), D-dimer (D-D), fibrinogen (FIB), GDF-15, and VEGF were higher than those in the non-ISR group, while CXCR4 was lower than that in the non-ISR group, and the differences were statistically significant (P<0.05). Increased levels of FIB, GDF-15, VEGF, and decreased levels of CXCR4 were independent risk factors for the development of ISR after PCI, and the differences were statistically significant (P<0.05). After further adjusting for the influence of FIB, GDF-15, VEGF, and CXCR4 remained associated with the development of ISR after PCI. The AUC of the combined prediction of serum GDF-15, VEGF, and CXCR4 for predicting ISR after PCI was significantly greater than that of each individual predictor, and the differences were statistically significant (P<0.05). Conclusion Serum GDF-15, VEGF and CXCR4 levels are significantly correlated with ISR in patients with coronary heart disease after PCI. All of them have predictive value for ISR, and combined detection can provide more reliable data support for clinical practice.

关键词

冠心病 / 支架再狭窄 / 生长分化因子-15 / 血管内皮生长因子 / CXC族趋化因子受体4

Key words

Coronary heart disease / Stent restenosis / Growth differentiation factor-15 / Vascular endothelial growth factor / CXC family chemokine receptor 4

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