2025 年第 1 期 第 0 卷

血清肝素辅因子-Ⅱ和二肽基肽酶4水平与药物涂层球囊扩张术后冠状动脉支架内再狭窄的关系

Relationship between serum levels of heparin cofactor-Ⅱ and dipeptidyl peptidase 4 and coronary artery in-stent restenosis after drug-coated balloon dilatation

作者：茂建梅  杨铠榕  郭娅娅

英文作者：Mao Jianmei Yang Kairong Guo Yaya

单位：延安大学附属医院心血管内科，延安716000

英文单位：Department of Cardiovascular Medicine Yan′an University Affiliated Hospital Yan′an 716000 China

关键词：支架内再狭窄；  药物涂层球囊；  肝素辅因子-Ⅱ；  二肽基肽酶4；  预测价值

英文关键词：In-stentrestenosis;  Drug-coatedballoon;  Heparincofactor-Ⅱ;  Dipeptidylpeptidase4; Predictivevalue

• 摘要：

• 目的  探讨血清肝素辅因子-Ⅱ（HC-Ⅱ）、二肽基肽酶4（DPP4）水平与药物涂层球囊（DCB）扩张术后冠状动脉支架内再狭窄（ISR）的关系。方法  选取2021年1月至2023年3月在延安大学附属医院行DCB扩张术的ISR患者158例，收集临床资料，采用酶联免疫吸附试验法检测血清HC-Ⅱ、DPP4水平。以ISR患者DCB扩张术后ISR为因变量，建立多因素非条件Logistic回归模型确定其影响因素；绘制受试者工作特征（ROC）曲线评价血清HC-Ⅱ、DPP4水平对ISR患者DCB扩张术后ISR的预测价值。结果  随访1年，158例ISR患者有54例（34.2%）DCB扩张术后发生ISR纳入ISR组，非ISR组104例。多因素非条件Logistic回归模型结果显示，ISR患者DCB扩张术后ISR的独立危险因素为DCB扩张术前管腔狭窄率增加、中性粒细胞与淋巴细胞比值升高、DPP4升高，独立保护因素为HC-Ⅱ升高（均P＜0.05）。ROC曲线显示，血清HC-Ⅱ、DPP4水平联合预测ISR患者DCB扩张术后ISR的曲线下面积为0.873，大于血清HC-Ⅱ、DPP4水平单独预测的0.789、0.788（均P＜0.05）。结论  血清HC-Ⅱ水平降低和DPP4水平升高与DCB扩张术后ISR密切相关，血清HC-Ⅱ、DPP4水平联合预测ISR患者DCB扩张术后冠状动脉ISR的价值较高。

• Objective  To investigate the relationship between serum levels of heparin cofactor-Ⅱ (HC-Ⅱ) and dipeptidyl peptidase 4 (DPP4) and coronary artery in-stent restenosis (ISR) after drug-coated balloon (DCB) dilation. Methods   A total of 158 ISR patients who underwent DCB expansion in Yan′an University Affiliated Hospital from January 2021 to March 2023 were selected. The clinical data were collected, and the serum levels of HC-Ⅱ and DPP4 were detected by enzyme-linked immunosorbent assay. Taking ISR after DCB expansion in ISR patients as the dependent variable, a multivariate unconditional Logistic regression model was established to determine its influencing factors. Receiver operating characteristic (ROC) curve was drawn to evaluate the value of serum HC-Ⅱ and DPP4 levels in predicting ISR after DCB dilatation. Results   After 1 year of follow-up, 54 of 158 ISR patients (34.2%) with ISR after DCB expansion were included in the ISR group, and 104 patients were in the non-ISR group. Multivariate Logistic regression analysis showed that increased stenosis rate of the official carity, increased neutrophil to lymphocyte ratio and increased DPP4 were independent risk factors for ISR after DCB expansion, and increased HC-Ⅱ was an independent protective factor (all P＜0.05). The ROC curve showed that the area under the curve (AUC) of the combination of serum HC-Ⅱ and DPP4 levels in predicting ISR after DCB dilatation was 0.873, which was larger than 0.789 and 0.788 of HC-Ⅱ and DPP4 levels alone (all P＜0.05）. Conclusion   The decrease of serum HC-Ⅱ level and the increase of DPP4 level are closely related to ISR after DCB dilatation. The combination of serum HC-Ⅱ and DPP4 levels has a higher value in predicting coronary artery ISR after DCB dilatation in patients with ISR.