标题：SAA、VCAM-1与冠心病患者PCI术后氯吡格雷抵抗的关系及对预后的预测价值

      作者：曹金龙，马鸿兰，蔡天志    西安医学院第一附属医院心内科，陕西 西安 710077

      卷次： 2023年34卷23期

      【摘要】 目的 分析淀粉样蛋白酶A(SAA)、血管细胞黏附分子-1 (VCAM-1)与冠心病患者经皮冠状动脉介入(PCI)术后氯吡格雷抵抗的关系及其对预后的预测价值。方法 纳入2020年5月至2022年5月西安医学院第一附属医院心内科行PCI治疗的130例冠心病患者，检测术后36 h血清SAA、VCAM-1水平及血小板抑制率，依据血小板抑制率将其分为抵抗组(n=28)和非抵抗组(n=102)。比较两组患者的一般资料及血清SAA、VCAM-1水平，采用Logistic回归分析氯吡格雷抵抗的独立相关因素，根据术后 6个月不良心血管事件发生情况分为预后良好组105例和预后不良组 25例，比较两组患者的血清SAA、VCAM-1水平，采用受试者工作特征曲线(ROC)评估血清SAA、VCAM-1对患者不良预后的预测价值。结果 抵抗组与非抵抗组患者的一般资料比较差异均无统计学意义(P>0.05)；抵抗组患者的血清SAA、VCAM-1水平分别为(13.48±4.21) mg/L、(1 277.13±216.46) ng/mL，明显高于非抵抗组的(9.74±2.81) mg/L、(1 016.34±145.72) ng/mL，差异均具有统计学意义(P<0.05)；经Logistic回归分析结果显示，SAA、VCAM-1均为冠心病患者 PCI术后氯吡格雷抵抗的独立相关因素(P<0.05)；预后不良组患者的血清SAA、VCAM-1水平分别为(14.19±3.92) mg/L、(1 392.76±185.23) ng/mL，明显高于预后良好组的(9.67±2.87) mg/L、(1 002.39±139.87) ng/mL，差异均有统计学意义(P<0.05)；经ROC分析结果显示，血清SAA、VCAM-1单独及联合预测PCI术后不良心血管事件的曲线下面积(AUC)分别为 0.774、0.805、0.937。结论 SAA、VCAM-1是冠心病PCI术后氯吡格雷抵抗的独立相关因素，联合检测对术后不良心血管事件具有一定的预测价值。
      【关键词】 冠心病；经皮冠状动脉介入；氯吡格雷抵抗；淀粉样蛋白酶A；血管细胞黏附分子-1；不良心血管事件
      【中图分类号】 R541.4 【文献标识码】 A 【文章编号】 1003—6350（2023）23—3372—04

Relationship between SAA, VCAM-1 and clopidogrel resistance in patients with coronary heart disease after PCIand its predictive value for prognosis.
CAO Jin-long, MA Hong-lan, CAI Tian-zhi. Department of Cardiology, FirstAffiliated Hospital of Xi'an Medical College, Xi'an 710077, Shaanxi, CHINA
【Abstract】 Objective To analyze the relationship between serum amyloid A (SAA), vascular cell adhesionmolecule-1 (VCAM-1) and clopidogrel resistance in patients with coronary heart disease after percutaneous coronary in-tervention (PCI) and its predictive value for prognosis. Methods A total of 130 patients with coronary heart diseasewho underwent PCI in the Department of Cardiology, First Affiliated Hospital of Xi'an Medical College from May 2020to May 2022 were enrolled. Serum SAA, VCAM-1 levels and platelet inhibition rate were measured 36 hours after oper-ation. According to platelet inhibition rate, they were divided into resistance group (n=28) and non-resistance group (n=102). The general data and serum SAA and VCAM-1 levels were compared between the two groups. Logistic regressionwas used to analyze the independent related factors of clopidogrel resistance. According to the occurrence of adverse car-diovascular events at 6 months after operation, the patients were divided into good prognosis group (105 cases) and poorprognosis group (25 cases). The serum SAA and VCAM-1 levels were compared between the two groups. The receiver op-erating characteristic curve (ROC) was used to evaluate the predictive value of serum SAA and VCAM-1 on the poor prog-nosis of patients. Results There were no statistically significant differences in general data between the two groups (P>0.05). The serum SAA and VCAM-1 levels in the resistance group were (13.48±4.21) mg/L and (1 277.13±216.46) ng/mL,respectively, which were significantly higher than (9.74±2.81) mg/L and (1 016.34±145.72) ng/mL in the non-resistancegroup (P<0.05). Logistic regression analysis showed that SAA and VCAM-1 were independent related factors of clopi-dogrel resistance in patients with coronary heart disease after PCI (P<0.05). The serum SAA and VCAM-1 levels in thepoor prognosis group were (14.19±3.92) mg/L and (1 392.76±185.23) ng/mL, respectively, which were significantlyhigher than (9.67±2.87) mg/L and (1 002.39±139.87) ng/mL in the good prognosis group (P<0.05). The results of ROCanalysis showed that the area under the ROC curve (AUC) of serum SAA, VCAM-1 alone and in combination in predict-ing adverse cardiovascular events after PCI was 0.774, 0.805, and 0.937, respectively. Conclusion SAA and VCAM-1are independent related factors of clopidogrel resistance after PCI in coronary heart disease. Combined detection has cer-tain predictive value for postoperative adverse cardiovascular events.
      【Key words】 Coronary heart disease; Percutaneous coronary intervention; Lopidogrel resistance; Serum amyloidA (SAA); Vascular cell adhesion molecule-1 (VCAM-1); Adverse cardiovascular events