作者：赵慧，程功，王依阳，蒋红英，梁宸源，姜瑞嘉，陈亮

单位：

710068陕西省西安市，陕西省人民医院心血管内二科

单位（英文）：

Department of Cardiology, Shaanxi Provincial People's Hospital, Xi'an 710068, China

关键词：

　冠心病；经皮冠状动脉介入治疗；冠状动脉微血管疾病；肿瘤坏死因子配体超家族成员18；人内皮 细胞特异性分子1；预测

关键词（英文）：

Coronary disease; Percutaneous coronary intervention; Coronary microvascular disease; Tumor necrosis factor ligand superfamily member 18; Endothelial cell specific molecule 1; Forecasting

中图分类号：

R 541.4

DOI：

10.12114/j.issn.1008-5971.2024.00.046

基金项目：

陕西省自然科学基金资助项目（2022JQ-891）；陕西省人民医院科技发展孵化项目（2021YJY-17）；陕西省人民医 院科技创新领军人才项目（2022LJ-04）

摘要：

目的　探讨血清肿瘤坏死因子配体超家族成员18（TNFSF18）及人内皮细胞特异性分子1（ESM-1） 对冠心病患者PCI后发生冠状动脉微血管疾病（CMVD）的预测价值。方法　选取2021年7月—2022年9月陕西省人民 医院行PCI的冠心病患者113例为研究对象。收集所有患者的临床资料，采用酶联免疫吸附试验（ELISA）检测血清 TNFSF18、ESM-1，冠状动脉血流储备（CFR）＜2.0判定为发生CMVD。采用多因素Logistic回归分析探讨冠心病患 者PCI后发生CMVD的影响因素，绘制ROC曲线以评估血清TNFSF18、ESM-1对冠心病患者PCI后发生CMVD的预测价 值。结果　113例患者中发生CMVD 78例（69.0%）。发生CMVD者淋巴细胞分数及血清TNFSF18、ESM-1高于未发 生CMVD者（P＜0.05）。多因素Logistic回归分析结果显示，血清TNFSF18〔OR=1.015，95%CI（1.005～1.024）〕、 ESM-1〔OR=1.008，95%CI（1.004～1.012）〕是冠心病患者PCI后发生CMVD的独立影响因素（P＜0.05）。ROC 曲线分析结果显示，血清TNFSF18、ESM-1预测冠心病患者PCI后发生CMVD的曲线下面积分别为0.818〔95%CI （0.740～0.896）〕、0.757〔95%CI（0.666～0.847）〕，最佳截断值分别为253 ng/L、84 ng/L，灵敏度分别为80.8%、 57.7%，特异度分别为74.3%、82.9%。结论　血清TNFSF18、ESM-1是冠心病患者PCI后发生CMVD的独立影响因素， 且其对冠心病患者PCI后发生CMVD有一定预测价值。

英文摘要：

Objective To explore the predictive value of serum tumor necrosis factor ligand superfamily member 18 (TNFSF18) and endothelial cell specific molecule 1 (ESM-1) for coronary microvascular disease (CMVD) after PCI in patients with coronary heart disease. Methods A total of 113 coronary heart disease patients who underwent PCI at Shaanxi Provincial People's Hospital from July 2021 to September 2022 were selected as the study subjects. The clinical data of the patients were collected, the serum TNFSF18 and ESM-1 were detected by enzyme linked immunosorbent assay (ELISA) , the patients were determined occurrence of CMVD according to the coronary flow reserve (CFR) < 2.0. Multivariate Logistic regression analysis was used to explore the influencing factors of CMVD after PCI in patients with coronary heart disease. The ROC curve was drawn to explore the predictive value of the serum TNFSF18 and ESM-1 for CMVD after PCI in patients with coronary heart disease. Results Among 113 patients, 78 (69.0%) developed CMVD. The lymphocyte fraction, serum TNFSF18 and ESM-1 in the patients with CMVD were higher than those in the patients without CMVD (P < 0.05) . Multivariate Logistic regression analysis showed that serum TNFSF18 [OR=1.015, 95%CI (1.005-1.024) ] and ESM-1 [OR=1.008, 95%CI (1.004-1.012) ] were the independent influencing factors of CMVD after PCI in patients with coronary heart disease (P < 0.05) . ROC curve analysis showed that the AUC of the serum TNFSF18 and ESM-1 for predicting CMVD after PCI in patients with coronary heart disease was 0.818 [95%CI (0.740-0.896) ] , 0.757 [95%CI (0.666-0.847) ] , respectively. The optimal cut-off value was 253 ng/L and 84 ng/L, the sensitivities was 80.8% and 57.7%, and specificities were 74.3% and 82.9%, respectively. Conclusion Serum TNFSF18 and ESM-1 are the independent influencing factors of CMVD after PCI in patients with coronary heart disease, and they have certain predictive value for CMVD after PCI in patients with coronary heart disease.

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