循环microRNA-21及可溶性CD40L与不稳定斑块的关系

The association among circulating microRNA-21,soluable CD40 ligand and unstable plague in patients with coronary artery disease

目的：探讨冠心病（CHD）患者循环microRNA-21（miRNA-21）相对表达量及可溶性CD40L（sCD40L）的表达水平与不稳定斑块的关系。方法：选择住院并接受冠状动脉造影（CAG）及血管内超声（IVUS）检查的CHD患者100例,根据IVUS检查结果分为稳定斑块组（SP组）45例、不稳定斑块组（UP组）55例,并选择同期进行健康体检的50例健康人群作为对照组。测定并比较备组患者血浆miRNA 21的相对表达量及血清sCD40L的水平,分析血浆miRNA-21、血清sCD40L水平与CHD患者不稳定斑块的关系。结果：不稳定斑块组患者血浆miRNA-21相对表达量[（0.87±0.10）：（0.78±0.11）：（0.67±0.08）,P〈0.05]、血清sCD40L水平[（283.67±45.28）pg/ml：（267.55±46.37）pg/ml：（248.36±44.85）pg/ml,P〈0.05]显著高于稳定斑块组和对照组。将CHD患者血浆miRNA-21、血清sCD40L水平分别与患者是否存在不稳定斑块做出受试者工作曲线（ROC）,血浆miRNA 21的曲线下面积（AUC）为0.879（95%CI：0.874-0.972）,而血清sCD40L的AUC为0.832（95%CI：0.81 5-0.942）。Pearson相关分析显示,不稳定斑块组血浆miRNA-21水平与血清sCD40L水平呈正相关（r=0.667,P=0.012）。多因素Logistic回归分析显示,血浆miRNA-21与血清sCD40L水平均是CHD患者存在不稳定斑块的独立预测因子（P〈0.05）。结论：血浆miRNA-21与血清sCD40L水平升高预示CHD患者冠状动脉内斑块的不稳定状态,miRNA-21通过调控炎性递质sCD40L水平可能是影响斑块稳定性的重要机制之一。

Objective：To investigate the association among circulating microRNA-21（miR-21）,soluble CD40ligand（sCD40L） and unstable plague in patients with coronary heart disease（CHD）.Method：One hundred consecutive patients with CHD were enrolled.All patients,who underwent coronary angiograph and intravascular ultrasound（IVUS） examination,were divided into two groups：stable plague group（n=45） and unstable plague group（n=55）.Fifty healthy people who accept physical examination during the same periods were enrolled as control group.Plasma miRNA-21,serum sCD40 L of patients were measured and compared in three groups.And the correlation of plasma miRNA-21 and serum sCD40 L in patients with unstable plague was analyzed.Result：The levels of plasma miRNA-21[（0.87 ± 0.10） vs（0.78 ± 0.11） vs（0.67 ± 0.08）,P〈0.05],serum sCD40L[（283.67 ±45.28）pg/ml vs（267.55 ± 46.37）pg/ml vs（248.36 ± 44.85）pg/ml,P〈0.05]in patients of unstable plague group were significant higher than those in stable plague group and control group.The receiver operation curve（ROC） showed that the AUC of plasma miRNA-21 was 0.879（95%CI：0.874-0.972） and serum sCD40 L was0.832（95%CI：0.815-0.942）.Multivariate logistic regression analysis showed that plasma miRNA-21 and serum sCD40 L were two independent predicative factors for unstable plague in patients with CHD（P〈0.05）.Pearson correlation analysis indicated that the levels of plasma miRNA-21 and serum sCD40 L was positive correlatedwith unstable plaguein CHD patients（r=0.667,P = 0.012）.Conclusion：The increasing levels of plasma miRNA-21 and serum sCD40 L predicate the unstable condition of coronary plague in CHD patients.miRNA-21 modulates sCD40 L,a major inflammatory mediator,which maybe one crucial mechanism in affecting the stability of coronary plague.