| Nowadays,under the influence of economic and social environment and other factor,people's work and life style are constantly changing.Cardiovascular disease?CAD?is not only the main cause of death in various provinces in China,but also concerned by people all over the world as a global health hot issue.Acute coronary syndrome?ACS?is especially common because of its high risk of death.Nowadays,stent implantation?PCI?has become the best treatment for coronary heart disease,and more and more patients receive PCI,but the influencing factors of in-stent restenosis?ISR?have not been completely solved.Drug-eluting stents?DES?and anticoagulant updates reduced the incidence of ISR to about 10%[1,2].The incidence of restenosis after stenting in diabetic patients was about 4 times higher than that in non-diabetic patients,and the prognosis of most patients was poor[4,5].Coronary heart disease and type 2 diabetes have been clinically proved to be chronic inflammatory diseases,there are metabolic disorders and immune abnormalities and other pathological basis,and this persistent chronic inflammation is also considered to be closely related to the occurrence of ISR[6].Some studies have shown that inflammatory bodies,as a part of the innate immune system,play a central role in inflammatory response,and it has been proved to be involved in the development of type 2 diabetes mellitus complicated with coronary heart disease.NLRP3 is the most common inflammatory body,which participates in innate immune response,initiates and activates inflammatory response signals[7].Therefore,we will analyze the relationship between NLRP3 inflammatory bodies and restenosis after PCI in patients with ACS complicated with T2DM.Objective:to compare the contents of IL-1?and IL-18 in plasma of patients in different patient groups,and to compare the difference of mRNA transcription and protein expression of NLRP3 inflammatory bodies in peripheral blood mononuclear cells?PBMCs?of different patient groups,and to clarify the relationship between IL-1?,IL-18,NLRP3 inflammatory bodies and restenosis after PCI in patients with ACS complicated with T2DM.The correlations between plasma IL-1?,IL-18 and NLRP3 mRNA transcription and protein expression were analyzed to explore the role of NLRP3inflammatory bodies in the process of restenosis after PCI in patients with ACS complicated with T2DM.Methods:1.Case collection and grouping:134 patients with ACS and T2DM who had been diagnosed as acute coronary syndrome and underwent drug-eluting stent implantation in the Department of Cardiology of Yanda affiliated Hospital from October 2018 to December 2019 were divided into restenosis group?ISR group,n=52?and non-restenosis group?NISR group,n=82?according to the results of CAG reexamination and coronary CTA.2.Collect the general data such as gender and age of all patients,clinical biochemical data such as GLU,TG,TC,EF value,stent diameter,stent length,Gensini score and other imaging and surgical data.3.Use EDTA anticoagulation tube to collect 5ml of cubital venous blood in the patients?fasting in the morning?,and isolate all patients'serum and PBMCs and store in-80?cryogenic refrigerator.4.Detection of NLRP3 mRNA transcription level in PBMCs of two groups of patients by RT-qPCR method.5.The expression of NLRP3 protein in PBMCs of the two groups was det-ected by Westernblot method.6.The contents of IL-1?and IL-18 in plasma of the two groups were determined by ELISA method.7.All the above indexes of the two groups were statistically analyzed to determine the role of NLRP3 inflammatory bodies in the process of restenosis after PCI in T2DM with ACS group.Results:1.There was no significant difference in general clinical data between the two groups?P>0.05?.2.There was no significant difference in Clinical biochemical and imaging data results between the two groups?P>0.05?.3.Results of clinical operation data:The two groups of patients compared the two indicators of stent diameter and Gensini score?P<0.05?,the difference was statistically significant;except for these two other indicators,the difference was not statistically significant?P>0.05?.4.ELISA test results:?1?the content of IL-1?in plasma of patients with ISR was?25.74±3.30?ng/L,which was significantly higher than that of patients with NISR?19.08±3.68?ng/L,?P<0.05?.?2?the content of IL-18 in plasma of patients with ISR was?129.00±19.78?ng/L,which was significantly higher than that of patients with NISR?105.82±12.74?ng/L,?P<0.05?.5.The expression level of NLRP3 protein in peripheral blood PBMCs of ISR group was significantly higher than that of NISR group?P=0.000?;the expression level of NLRP3 mRNA in peripheral blood PBMCs of ISR group was significantly higher than that of NISR group,and the difference was statistically significant?P=0.000?.6.Multivariate Logistic regression analysis showed that restenosis ISR?yes=1,no=0?was taken as dependent variable and stent diameter,Gensini score,IL-1?and IL-18,the expression level of NLRP3 protein and mRNA as covariates in multivariate Logistic regression analysis.Multivariate Logistic regression analysis showed that stent diameter,IL-1?and IL-18,NLRP3protein and mRNA were independent risk factors for ISR.7.The ROC curve analysis of IL-1?and IL-18 to ISR showed that the area under IL-1?and IL-18 curve AUC was 0.906 and 0.843 respectively,the sensitivity was 76.9%and 76.9%,and the specificity was 90.2%and91.5%,respectively.It is suggested that IL-1?and IL-18 have good predictive significance for the occurrence of ISR in patients with ACS complicated with T2DM.8.Correlation analysis:?1?Plasma IL-1?:in ISR group,this factor was positively correlated with NLRP3 protein?r=0.361,p=0.009?and NLRP3 mRNA?r=0.306,p=0.027?in PBMCs.In NISR group,this factor was positively correlated with NLRP3protein?r=0.235,p=0.034?and NLRP3 mRNA?r=0.298,p=0.007?in PBMCs.?2?plasma IL-18:in ISR group,this factor was positively correlated with NLRP3 protein?r=0.274,p=0.049?and NLRP3 mRNA?r=0.389,p=0.004?in PBMCs.In NISR group,this factor was positively correlated with NLRP3protein?r=0.382,p=0.000?and NLRP3 mRNA?r=0.224,p=0.043?in PBMCs.Conclusion:1.IL-1?and IL-18 are involved in the occurrence of restenosis after PCI in patients with ACS complicated with T2DM,and IL-1?and IL-18 have high predictive value in the occurrence of restenosis.2.NLRP3 inflammatory bodies are involved in the occurrence of restenosis after PCI in patients with ACS and T2DM,and NLRP3inflammatory bodies may play a pro-inflammatory role through downstream inflammatory factors IL-1?and IL-18. |
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