循环miR-146a水平对亚临床甲状腺功能减退症病人冠状动脉粥样硬化性心脏病的预测价值观察

Predictive Value of Circulating miR-146a Level for Coronary Heart Disease in Patients with Subclinical Hypothyroidism

目的探讨循环miR-146a水平对亚临床甲状腺功能减退症病人冠状动脉粥样硬化性心脏病(冠心病)的预测价值。方法选择2015年1月—2018年1月在我院就诊的246例亚临床甲状腺功能减退症病人作为研究对象,以冠脉造影为金标准,观察病人一般情况、实验室检查指标与冠心病发病的相关性。结果 246例病人检出冠心病102例,检出率为41.46%,冠心病组miR-146a表达量为2.209±0.636,非冠心病组miR-146a表达量为1.586±0.586,差异有统计学意义(t=7.925,P <0.001)。单因素分析显示,饮酒不是亚临床甲状腺功能减退症病人冠心病发病的危险因素(P>0.05),性别、年龄、体重指数、冠心病家族史、吸烟、高血压、糖尿病、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)、三酰甘油(TG)、血清同型半胱氨酸(Hcy)、血清促甲状腺激素(TSH)是影响亚临床甲状腺减退症病人冠心病发病的危险因素(P <0.05)。多因素Logistic分析结果显示,年龄≥60岁、糖尿病、LDL-C≥3.12 mmol/L、血清促甲状腺激素(TSH)≥10 mIU/L、miR-146a是影响亚临床甲状腺功能减退症病人冠心病发病的独立危险因素(P <0.05)。ROC显示,miR-146a预测冠心病的灵敏度、特异性、Cut-off、AUC和95%CI分别是62.75%、82.64%、2.06、0.767和0.709～0.818。结论 miRNA-146a是亚临床甲状腺功能减退症病人冠心病发病的独立危险因素,血浆miR-146a水平对亚临床甲状腺功能减退病人冠心病具有一定的预测价值。

Objective To explore the predictive value of circulating miR-146a level for coronary heart disease in patients with subclinical hypothyroidism.Methods Two hundreds and forty-six patients with subclinical hypothyroidism in our hospital from January 2015 to January 2018 were selected as the objects.Using coronary angiography as the gold standard,this study observed the correlation between general condition,laboratory examination index and coronary heart disease.Results In 246 cases of subclinical hypothyroidism,102 cases were diagnosed with coronary heart disease,and the detection rate was 41.46%.The expression of miR-146a in coronary heart disease group was(2.209±0.636),and the expression of miR-146a in non coronary heart disease group was(1.586±0.586),and the difference was statistically significant(t=7.925,P<0.001).The univariate analysis showed that alcohol consumption was not a risk factor for coronary heart disease in patients with subclinical hypothyroidism(P>0.05),and the gender,age,body mass index,family history of coronary heart disease,smoking,hypertension,diabetes,low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol (HDL-C),TC,triglyceride(TG),homocysteine(Hcy),thyroid stimulating hormone (TSH) were the risk factors for the incidence of coronary heart disease in patients with subclinical hypothyroidism(P<0.05).The results of multifactor Logistic analysis showed that age≥60,diabetes,LDL C≥3.12mmol/L,TSH≥10mIU/L and miR-146a were independent risk factors affecting the incidence of coronary heart disease in subclinical hypothyroidism(P<0.05).ROC showed that the sensitivity,specificity,Cut-off,AUC and95%CI of miR-146a in predicting coronary heart disease were62.75%,82.64%,2.06,0.767,and 0.709-0.818,respectively.Conclusion The miRNA-146a is an independent risk factor for coronary heart disease in subclinical hypothyroidism patients,and the plasma miR-146a level is of certain predictive value for coronary heart disease in patients with subclinical hypothyroidism.