血清miRNA-1、miRNA-21检测预测PCI术后患者再狭窄的临床价值

Value of the expression of miRNA-1,miRNA-21 in serum for predicting in-stent restenosis of expanded area after percutaneous coronary intervention

目的探讨血清中miRNA-1、miRNA-21水平检测对经皮冠状动脉介入术(PCI)后患者半年内扩张部位再狭窄的临床预测价值。方法选取2014年5月至2016年5月在延安大学咸阳医院接受PCI术的70例冠心病患者(再狭窄组37例,未狭窄组33例),行血管内超声(IVUS)检查,并选择33例体检健康者(对照组),检测各组血清中miRNA-1、miRNA-21水平,采用t检验、Pearson相关性分析及建立受试者工作曲线(ROC曲线)进行比较分析。结果血清miRNA-1在再狭窄组、未狭窄组和对照组中的表达水平分别为(0.23±0.05)、(0.35±0.09)、(0.91±0.13),血清miRNA-21的水平分别为(0.85±0.15)、(0.36±0.08)、(0.20±0.03)。再狭窄组血清miRNA-1水平明显低于对照组,miRNA-21水平则明显高于对照组。而与未狭窄组比较,再狭窄组miRNA-1水平显著下调,miRNA-21水平则显著上调,差异均有显著统计学意义(P<0.01)。IVUS结果显示PCI术后再狭窄组外弹力膜内横截面积(EEM)、斑块面积(PLA)和最小管腔面积(MLA)分别为(9.97±2.17)mm2、(11.28±2.75)mm2、(3.78±1.87)mm2;IVUS结果显示PCI术后未再狭窄组EEM、PLA和MLA分别为(13.66±2.28)mm2、(6.13±1.90)mm2、(6.07±2.07)mm2。再狭窄组与未狭窄组比较,PLA显著增高,EEM和MLA显著降低。再狭窄组miRNA-21水平分别与EEM、PLA和MLA有明显的相关性(r=-0.588,P<0.01;r=0.583,P<0.01;r=-0.608,P<0.01);再狭窄组miRNA-1水平分别与EEM、PLA和MLA有相关性(r=0.613,P<0.01;r=-0.605,P<0.01;r=0.593,P<0.01)。再狭窄组的血清miRNA-1与miRNA-21水平呈负相关(r=-0.657,P<0.01)。ROC曲线分析显示,血清miRNA-21水平的AUC为0.751(95%CI:0.687~0.892,P=0.000);血清miRNA-1水平的AUC为0.722(95%CI:0.679~0.883,P=0.000)。根据SPSS统计结果计算出miRNA-21在最佳临界值处诊断PCI术后再狭窄发生及狭窄程度监测的敏感性和特异性为96.9%和95.3%,miRNA-1的敏感性和特异性为90.6%和95.3%。结论检测PCI术后患者血清中miRNA-1、miRNA-21水平可以预测其扩张部位再狭窄的发生。

Objective To explore the clinical predictive value of the expression of miRNA-1, miRNA-21 in serum for the in-stent restenosis （ISR） of expanded area after percutaneous coronary intervention （PCI） in half a year. Methods From May 2014 to May 2016, 70 patients with coronary heart disease undergoing PCI （37 patients in ISR group and 33 patients in non-ISR group） were selected from Xianyang Hospital of Yan＆#39;an University and received intra-vascular ultrasound （IVUS） examination. At the same time, 33 healthy volunteers were enrolled as the control group.The levels of serum miRNA-1, miRNA-21 were measured, compared, and analyzed by t test, Pearson correlation analy-sis and ROC curve. Results The levels of miRNA-1 in ISR group, non-ISR group and control group were （0.23±0.05）, （0.35±0.09）, （0.91±0.13）, respectively, and the miRNA-21 levels were （0.85±0.15）, （0.36±0.08）, （0.20±0.03）, respectively. The level of miRNA-1 in ISR group was significantly lower than that in the control group （P〈0.01）, while miR-NA-21 were significantly higher （P〈0.01）. The level of miRNA-1 in ISR group was significantly lower in comparing with that in non-ISR group, while miRNA-21 were significantly higher （P〈0.01）. The results from IVUS examination showed that in the ISR group, external elastic membrane （EEM）, plaque area （PLA） and the minimal lumen area （MLA） were, respectively, （9.97±2.17） mm2, （11.28±2.75） mm2, （3.78±1.87） mm2, as compared with （13.66±2.28） mm2, （6.13± 1.90） mm2, （6.07 ± 2.07） mm2 in non-ISR group, with statistically significant differences. The level of miRNA-21 in the ISR group had a significant correlation with EEM, PLA and MLA （r=-0.588, P〈0.01; r=0.583, P〈0.01; r=-0.608, P〈0.01）, and miRNA-1 also showed a significant correlation with EEM, PLA and MLA （r=0.613, P〈0.01; r=-0.605, P〈0.01;r=0.593, P〈0.01）. There was a negative correlation between the levels of miRNA-1, miRNA-21 in the ISR group （r=-0.657, P〈0.01）. The results from ROC curve analysis showed that AUC of the levels of serum miRNA-21 was 0.751 （95% CI： 0.687-0.892, P=0.000）, and that of serum miRNA-1 was 0.722 （95% CI： 0.679-0.883, P=0.000）. SPSS statistics showed that the sensitivity and specificity on the best critical value in diagnosing the occurrence of restenosis after PCI and monitoring stenosis degree were, respectively, 96.9% and 95.3% （miRNA-21）, 90.6% and 95.3%（miRNA-1）. Conclusion The detection of the levels of miRNA-1, miRNA-21 can predict the occurrence of restenosis of expanded area in postoperative patients with PCI.