内科

目的探讨转化生长因子（TGF）-β1基因多态性联合血清血小板衍生生长因子（PDGF）-BB和C反应蛋白（CRP）水平对急性冠脉综合征（ACS）患者经皮冠状动脉介入（PCI）术后冠状动脉支架内再狭窄（ISR）的预测价值。方法选取264例行PCI治疗的ACS患者作为研究对象，并根据随访期间是否发生ISR将其分为ISR组和非ISR组。采用单因素分析和二元logistic回归分析对影响ACS患者PCI术后发生ISR的因素进行分析，构建ACS患者PCI术后发生ISR的预测模型。采用受试者操作特征（ROC）曲线分析各因素的预测效能。结果264例患者中，70例随访期间内发生ISR（ISR组），194例未发生ISR（非ISR组），发生率为26.5%。ISR组TGF-β1基因509C>T（rs1800469）位点为CC型患者的比例高于非ISR组（54.3% 比30.4%，P＜0.05）。ISR组患者血清PDGF-BB、CRP水平均高于非ISR组（均P＜0.05）。二元logistic回归分析结果提示，TGF-β1基因509C>T（rs1800469）位点为CC型、血清PDGF-BB和CRP水平升高均是ACS患者PCI术后发生ISR的独立危险因素（均P＜0.05）。ROC曲线分析提示，TGF-β1基因509C>T（rs1800469）位点基因型、血清PDGF-BB水平、血清CRP水平预测ACS患者PCI术后发生ISR的曲线下面积（AUC）分别为0.866、0.786和0.861，而三者联合的AUC为0.970（均P＜0.05），最终预测模型为P=1/［1+e(-17.015+0.160*PDGF-BB+1.139*CRP+2.517*TGF-β1）］。结论TGF-β1基因多态性和血清PDGF-BB、CRP水平与ACS患者PCI术后ISR的发生密切相关，上述三个指标联合有助于预测PCI术后ISR的发生情况。

ObjectiveTo investigate the predictive value of transforming growth factor (TGF)-β1 gene polymorphism combined with serum platelet-derived growth factor (PDGF)-BB and C-reactive protein (CRP) levels for coronary artery in-stent restenosis (ISR) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). MethodA total of 264 ACS patients treated with PCI were enrolled as research subjects and divided into an ISR group or a non-ISR group according to whether they developed ISR during the follow-up period. Univariate analysis and binary logistic regression analysis were used to analyze factors affecting the occurrence of ISR in ACS patients after PCI, and a predictive model for the occurrence of ISR in ACS patients after PCI was constructed. The receiver operating characteristics (ROC) curve was used to analyze each factor′s predictive efficacy. ResultsOf the 264 patients, 70 patients develop ISR (ISR group) and 194 patients did not develop ISR (non-ISR group) during the follow-up period, with an incidence of 26.5%. The proportion of patients whose TGF-β1 gene 509C>T (rs1800469) locus was CC type in the ISR group was higher than that in the non-ISR group (54.3% vs. 30.4%, P＜0.05). The serum levels of PDGF-BB and CRP in the ISR group were higher than those in the non-ISR group (all P＜0.05). The results of binary logistic regression analysis showed that the CC type at TGF-β1 gene 509C>T (rs1800469) locus and elevated serum levels of PDGF-BB and CRP were independent risk factors for the occurrence of ISR in ACS patients after PCI (all P＜0.05). The ROC curve analysis showed that the area under the curve (AUC) of the genotype of TGF-β1 gene 509C>T (rs1800469) locus, serum PDGF-BB level, and serum CRP level in predicting the occurrence of ISR in ACS patients after PCI were 0.866, 0.786, and 0.861, respectively, while their combination′s AUC reached 0.970 (all P＜0.05). The final predictive model was P=1/（1+e［-17.015+0.160*PDGF-BB+1.139*CRP+2.517*TGF-β1］）. ConclusionTGF-β1 gene polymorphism and serum PDGF-BB and CRP levels are closely related to the occurrence of ISR in ACS patients after PCI, and the combination of the abovementioned three indicators is helpful in predicting the occurrence of ISR after PCI.