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目的 探讨内皮脂酶在冠状动脉支架内再狭窄(ISR)患者中的表达差异,初步探讨其临床意义.方法 对2014年1月至2017年12月济宁医学院附属医院心内科收治的行冠状动脉造影(CAG)并置入药物洗脱支架( DES)的48 例患者的临床资料进行回顾性分析,根据首次支架后6个月至4年复查CAG的结果分为支架内再狭窄组(20例)与非支架内再狭窄组(28例).收集患者的一般资料与冠状动脉支架治疗情况.检测两组患者的空腹血糖、甘油三酯、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)及血清内皮脂酶水平.通过多因素logistic回归分析 ISR 的相关危险因素.通过 ROC 曲线评估内皮脂酶对 ISR 患者的临床识别能力.结果 支架内再狭窄组的2型糖尿病及吸烟的患者比例高于非支架内再狭窄组,差异有统计学意义(P<0.05).支架内再狭窄组的LDL-C及内皮脂酶均高于非支架内再狭窄组,差异有统计学意义(P<0.05).支架内再狭窄组的置入支架总长度大于非支架内再狭窄组,差异有统计学意义(P<0.05).多因素logistic回归分析显示,2型糖尿病、置入支架总长度和内皮脂酶都是ISR的危险因素. ROC曲线发现内皮脂酶对 ISR 具有一定的临床识别能力[AUC =0.757,95% CI(0.645 ~0.899),P<0.05].结论 2型糖尿病、置入支架总长度及内皮脂酶都是ISR的的独立危险因素,内皮脂酶与ISR密切相关,内皮脂酶对DES置入后的ISR有较好的预测能力.

Objective To investigate the difference of endothelial lipase ( EL) expression in in-stent restenosis(ISR)patients and its clinical significance. Methods A retrospective study was performed on 48 cases of patients who were admitted and underwent coronary angiography ( CAG) and drug-eluting stents(DES)from January 2014 to December 2017. According to the results of CAG review 6 months to 4 years after the first stent placement,patients were divided into the stent restenosis group(20 cases)and the non-stent restenosis group(28 cases).Fasting blood glucose,triglyceride,total cholesterol,LDL-C,HDL-C and serum EL levels were measured in the two groups.Multivariate logistic regression was used to analyze ISR risk factors.ROC curve was used to evaluate the clinical recognition ability of EL in ISR patients. Results The proportion of patients with type 2 diabetes and smoking in the stent restenosis group was higher than that in the non-stent restenosis group(P<0.05).LDL-C and EL in the stent restenosis group were higher than those in the non-stent restenosis group(P<0.05).The total length of stent implantation in the restenosis group was greater than that in the non-restenosis group( P<0.05). Multivariate logistic re-gression analysis showed that type 2 diabetes mellitus,total stent length and EL were all risk factors for ISR. ROC curve showed that EL had certain clinical recognition ability for ISR [ AUC =0.757,95% CI (0.645 ~ 0.899),P<0.05]. Conclusion Type 2 diabetes,the total length of stent placement and EL are independent risk factors for ISR.EL is closely related to ISR,which has a better predictive ability for ISR after DES implantation.