Predictive value of FIB-4 Index in stent restenosis after PCI in patients with acute myocardial infarction
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摘要: 目的 探讨FIB-4指数预测急性心肌梗死(AMI)患者冠状动脉介入(PCI)术后支架内再狭窄(ISR)的价值。方法 选取我院心内科确诊为AMI并行PCI术的患者159例，根据随访冠状动脉造影结果分为无支架内再狭窄(NISR)组及ISR组。比较两组基本临床资料、手术资料、PCI术后服药情况、PCI前及随访时实验室结果等。采用多因素logistic回归分析发生ISR的相关因素，ROC曲线评价FIB-4预测ISR临床价值。结果 两组年龄、性别、高血压、糖尿病、术后服用药物及PCI前实验室结果等比较均无统计学差异(P＞0.05)。与NISR组相比，ISR组行急诊PCI比例低(P＜0.05)。ISR组随访时HDL-C水平及FIB-4指数显著高于NISR组(P＜0.05)。多因素logistic回归分析显示，随访时FIB-4指数(OR=3.022，P=0.032)是ISR发生的独立危险因素。随访时FIB-4指数ROC曲线下面积为0.632(95%CI：0.524~0.740，P=0.024)，诊断临界值为0.474，灵敏度为73.3%，特异度为52.7%。结论 PCI术后随访时FIB-4指数是发生ISR的危险因素。Abstract: Objective To explore the predictive value of FIB-4 index in stent restenosis after percutaneous transluminal coronary intervention(PCI) in patients with acute myocardial infarction(AMI).Methods A total of 159 patients with AMI received PCI in our hospital from June 2018 to October 2020. According to the results of re-examined for coronary angiography, they were divided into non-stent restenosis group(NISR group) and in-stent restenosis group(ISR group). The basic clinical data, surgical data, medications after PCI, laboratory results before the PCI and follow-up were compared. The multivariate logistic regression was used to analyze the related factors of ISR, and the ROC curve was used to evaluate FIB-4 to the clinical value of ISR.Results There were no significant differences in age, gender, hypertension, diabetes, postoperative drug use and laboratory results before PCI between the two groups(P> 0.05). Compared with the NISR group, the rate of emergency PCI in the ISR group was lower(P< 0.05). The HDL-C level and FIB-4 index in the ISR group were significantly higher than those in the NISR group at follow-up(P< 0.05). Multivariate logistic regression analysis showed that FIB-4 index at follow-up(OR=3.022,P=0.032) was an independent risk factor for ISR. At follow-up, the area under the FIB-4 index ROC curve was 0.632(95%CI: 0.524-0.740,P=0.024), the diagnostic critical value was 0.474, the sensitivity was 73.3%, and the specificity was 52.7%.Conclusion FIB-4 index is a risk factor for ISR at follow-up after PCI.
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表 1 两组基本资料及术后服用药物比较
Table 1. Comparison of basic data and medications
X±S, M(P25, P75) 项目 NISR组(129例) ISR组(30例) χ2/t/Z P值 年龄/岁 55.86±10.34 59.97±10.98 1.937 0.055 男性/例(%) 105(81.4) 20(66.7) 3.141 0.076 急诊PCI/例(%) 50(38.8) 5(16.7) 5.251 0.022 分次PCI/例(%) 47(36.4) 9(30.0) 0.442 0.506 高血压/例(%) 60(46.5) 17(56.7) 1.005 0.316 糖尿病/例(%) 35(27.1) 11(36.7) 1.076 0.300 术前脑梗死病史/例(%) 7(5.4) 0(0) 1.703 0.192 术后服用药物/例(%) CCB 14(10.9) 5(16.7) 0.782 0.377 ACEI/ARB 66(51.2) 19(63.3) 1.449 0.229 β受体阻滞剂 101(78.3) 24(80.0) 0.042 0.837 随访周期/月 12.53(9.3，13.2) 11.95(6.91，13.01) -1.547 0.122 CCB：钙通道拮抗剂；ACEI/ARB：血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂。 
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表 2 两组PCI前及随访时检验资料比较
Table 2. Comparison of laboratory data before PCI and follow-up
X±S, M(P25, P75) 项目 NISR组(129例) ISR组(30例) /t/Z P值 PCI前 WBC/(×109·L-1) 9.00±2.93 8.49±2.66 0.874 0.384 PLT/(×109·L-1) 233.67±68.01 230.70±55.10 0.223 0.824 MPV/fL 8.59±1.34 8.64±1.08 -0.215 0.830 eGFR/[mL·min-1·(1.73m2)-1] 94.48±14.58 90.09±20.78 1.362 0.175 ALT/(U·L-1) 31.0(19.0，47.0) 22.5(17.0，43.0) -1.207 0.228 AST/(U·L-1) 41.0(26.0，107.5) 47.0(21.0，96.3) -0.229 0.819 TC/(mmol·L-1) 4.02(3.54，4.91) 3.90(3.38，4.64) -0.720 0.472 TG/(mmol·L-1) 1.60(1.08，2.35) 1.58(1.16，2.21) -0.117 0.907 HDL-C/(mmol·L-1) 0.96±0.22 0.98±0.24 -0.414 0.680 LDL-C/(mmol·L-1) 2.69±0.95 2.72±1.24 -0.154 0.878 FIB-4 0.85(0.40，1.66) 0.88(0.51，1.84) -0.713 0.476 随访时 WBC/(×109·L-1) 6.28±1.71 6.72±2.23 -1.204 0.230 PLT/(×109·L-1) 207.00±49.36 213.30±54.01 -0.611 0.542 MPV/fL 9.20±1.28 9.49±1.96 -1.003 0.317 eGFR/[mL·min-1·(1.73m2)-1] 92.93±14.77 87.78±17.96 1.650 0.101 ALT /(U·L-1) 23.0(17.0，31.5) 19.5(15.0，24.3) 0.114 0.114 AST /(U·L-1) 20.0(17.0.25.0) 16.75(14.0，19.0) 0.628 0.628 TC/(mmol·L-1) 2.92(2.53，3.35) 2.99(2.67，3.65) 0.327 0.327 TG/(mmol·L-1) 1.23(0.95，1.82) 1.36(0.92，1.93) 0.884 0.884 HDL-C/(mmol·L-1) 0.96±0.20 1.05±0.21 -2.583 0.012 LDL-C/(mmol·L-1) 1.57±0.53 1.69±0.67 -1.055 0.293 FIB-4 0.47(0.34，0.70) 0.62(0.45，0.87) -2.252 0.024
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表 3 多因素logistic回归分析
Table 3. Multivariate logistic regression analysis
自变量 BE Wald OR 95%CI P值 急诊PCI -1.108 3.732 0.330 1.053~7.173 0.053 随访时HDL-C 1.736 2.920 5.677 0.784~41.698 0.087 随访时FIB-4指数 1.106 4.586 3.022 1.053~7.173 0.032
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