标题：血清CXCL10、CCCK-18水平对伴糖尿病冠心病患者PCI术后短期预后的预测效能

      作者：呼庆华 1，郭晓艳 2，宋爱新 1    1.安阳市第三人民医院心内科，河南 安阳 455000；2.阜外华中心血管病医院心内科，河南 郑州 451450

      卷次： 2024年35卷12期

      【摘要】 目的 探讨血清CXC趋化因子配体10 (CXCL10)、细胞角蛋白18裂解片段(CCCK-18)水平对伴糖尿病冠心病患者经皮冠状动脉介入术(PCI)后短期预后的预测效能。方法 选取2020年12月至2022年12月在安阳市第三人民医院实施相应PCI手术的 149例伴糖尿病冠心病患者作为研究对象，采用酶联免疫吸附法检测血清CXCL10、CCCK-18水平。术后随访3个月，根据患者是否发生主要心血管不良事件(MACE)分为预后良好组121例和预后不良组28例。采用受试者工作特征曲线(ROC)评估血清CXCL10、CCCK-18水平对伴糖尿病冠心病患者PCI术后短期预后的预测效能，采用二分类Logistic逐步回归分析探讨伴糖尿病冠心病患者PCI术后短期预后的影响因素。结果 预后不良组患者冠状动脉评分(Gensini)≥70分和多支血管病变的占比分别为78.57%、89.29%，明显高于预后良好组的43.80%、60.33%，差异均有统计学意义(P<0.05)，其他临床资料比较差异均无统计学意义(P>0.05)；预后不良组患者的血清CXCL10、CCCK-18水平分别为(19.35±2.41) ng/mL、(306.45±33.69) U/L，明显高于预后良好组的(8.63±1.87) ng/mL、(218.36±22.15) U/L，差异均有统计学意义(P<0.05)；经ROC分析结果显示，血清CXCL10、CCCK-18水平预测伴糖尿病冠心病患者PCI术后短期预后的最佳截断值分别为13.51 ng/L、262.47 U/L，而两者联合预测的曲线下面积(AUC) 95%置信区间(95%CI)为0.912 (0.868~0.957)；经多因素Logistic逐步回归分析结果显示：Gensini评分≥70分、多支血管病变、CXCL10、CCCK-18均是伴糖尿病冠心病患者PCI术后短期预后的影响因素(P<0.05)。结论 伴T2DM冠心病PCI术后预后不良患者的血清CXCL10、CCCK-18水平较预后良好者明显升高，两者联合检测对术后不良心血管事件具有一定的预测效能。
      【关键词】 冠心病；2型糖尿病；CXC趋化因子配体10；细胞角蛋白18裂解片段；短期预后
      【中图分类号】 R541.4 【文献标识码】 A 【文章编号】 1003—6350（2024）12—1740—05

Predictive efficacy of serum CXC chemokine ligand 10 and caspase-cleaved cytokeratin-18 levels on theshort-term prognosis of coronary heart disease patients with diabetes mellitus after percutaneous coronaryintervention.
HU Qing-hua 1, GUO Xiao-yan 2, SONG Ai-xin 1. 1. Department of Cardiology, Anyang Third People'sHospital, Anyang 455000, Henan, CHINA; 2.Department of Cardiology, Fuwai Central China Cardiovascular Hospital,Zhengzhou 451450, Henan, CHINA
【Abstract】 Objective To explore the predictive effect of serum CXC chemokine ligand 10 (CXCL10) and cas-pase-cleaved cytokeratin-18 (CCCK-18) levels on the short-term prognosis of coronary heart disease patients with dia-betes after percutaneous coronary intervention (PCI). Methods A total of 149 coronary heart disease patients with dia-betes mellitus who underwent PCI in Anyang Third People's Hospital from December 2020 to December 2022 were se-lected as the study objects. Serum CXCL10 and CCCK-18 levels were detected by enzyme-linked immunosorbent assay.After 3 months of postoperative follow-up, the patients were divided into a good prognosis group (121 cases) and apoor prognosis group (28 cases) based on whether they had major adverse cardiovascular events (MACE). The predic-tive efficacy of serum CXCL10 and CCCK-18 levels on the short-term prognosis of coronary heart disease patientswith diabetes after PCI was evaluated using the receiver operating characteristic (ROC) curve. The factors influencingthe short-term prognosis of coronary heart disease patients with diabetes after PCI were analyzed using binary logisticstepwise regression analysis. Results The proportion of patients with a coronary artery score (Gensini)≥70 and thosewith multiple vessel lesions were 78.57% and 89.29% in the poor prognosis group, respectively, which were significant-ly higher than 43.80% and 60.33% in the good prognosis group (P<0.05). There was no statistically significant differ-ence in other clinical data (P>0.05). The serum levels of CXCL10 and CCCK-18 in the poor prognosis group were(19.35±2.41) ng/mL and (306.45±33.69) U/L, respectively, which were significantly higher than (8.63±1.87) ng/mLand (218.36±22.15) U/L in the good prognosis group (P<0.05). ROC analysis results showed that the best cutoff valuesof serum CXCL10 and CCCK-18 levels for predicting the short-term prognosis of coronary heart disease patients withdiabetes after PCI were 13.51 ng/L and 262.47 U/L, respectively, while the area under the ROC curve (AUC) (95%CI)predicted by CXCL10 combined with CCCK-18 was 0.912 (0.868-0.957). Multivariate logistic stepwise regression anal-ysis showed that Gensini score≥70, multi vessel lesions, CXCL10, CCCK-18 were all factors influencing theshort-term prognosis of coronary heart disease patients with diabetes after PCI (P<0.05). Conclusion The serum CX-CL10 and CCCK-18 levels in the patients with poor prognosis after PCI were significantly higher than those in patientswith good prognosis. The combined detection of CXCL10 and CCCK-18 has a certain predictive effect on adverse car-diovascular events after PCI.
      【Key words】 Coronary heart disease; Type 2 diabetes; CXC chemokine ligand 10; Caspase-cleaved cytokera-tin-18; Short-term prognosis