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目的探讨经皮冠状动脉介入治疗(PCI)术前增强的炎症性反应对急性血管并发症及早期冠脉事件的预测价值。方法按照前瞻性临床试验方案,连续选择100例行PCI治疗的稳定性(SAP)和不稳定性心绞痛(UAP)患者,于术前留取外周血标本,分别测定C反应蛋白(CRP)和白介素-6(IL-6)水平;通过冠状动脉造影和临床指标判定PCI术中及围术期血管并发症及术后冠脉事件。结果100例患者中,13例于术中发生急性管腔闭塞,1例于术后2 d发生亚急性血栓,均于闭塞处行PTCA和/或支架植入,恢复TIMIⅢ级血流。余84例术中无并发症发生;术后30 d临床随访,无缺血性事件及各种原因的死亡发生。血管并发症发生率在CRP下四分位数组与上四分位数组间差异具有统计学意义(P<0.05);IL-6水平在无并发症组和并发症组中位数分别为:4.25 (0.00～75.00)pg/ml和7.5(0.00～48.00)pg/ml,P<0.05;Logistic单因素回归分析表明,增高的CRP、IL-6水平、糖尿病和靶血管AHA/ACC分型是术中急性血管并发症的预测因素。结论PCI术前增高的CRP、IL-6水平可能与术中急性血管事件的发生率相关。
Objective To investigate the predictive value of enhanced inflammatory response before percutaneous coronary intervention (PCI) for acute vascular complications and early coronary events. Methods According to the prospective clinical trial, 100 consecutive patients undergoing PCI with unstable angina pectoris (SAP) and unstable angina pectoris (UAP) were enrolled. Peripheral blood samples were collected preoperatively for determination of C-reactive protein (CRP) and interleukin -6 (IL-6) levels were measured. Coronary complications and postoperative coronary events were evaluated by coronary angiography and clinical parameters. Results Of the 100 patients, 13 had acute lumen occlusion during operation and 1 had subacute thrombosis 2 days after operation. PTCA and / or stenting were implanted at the occlusion sites to restore TIMI grade Ⅲ blood flow. More than 84 cases of intraoperative no complications occurred; 30 days after the clinical follow-up, no ischemic events and deaths of various causes. The incidence of vascular complications was significantly different between the quartiles of the CRP and the upper quartile (P <0.05). The median of IL-6 levels in the uncomplicated and complication groups was 4.25 (0.00 ~ 75.00) pg / ml and 7.5 (0.00 ~ 48.00) pg / ml respectively, P <0.05; Logistic regression analysis showed that elevated CRP, IL-6, diabetes and target blood vessel AHA / Predictors of acute vascular complications. Conclusion The elevated levels of CRP and IL-6 before PCI may be related to the incidence of intraoperative acute vascular events.