老年急性心肌梗死患者血清微小核糖核酸-133a、微小核糖核酸-208a表达水平与冠状动脉病变程度相关性研究

The expression of serum microRNA-133a and microRNA-208a in elderly patients with acute myocardial infarction and their relationship with the severity of coronary artery disease

目的探讨老年急性心肌梗死(AMI)患者血清微小核糖核酸(miR)-133a、miR-208a表达水平,分析其对冠状动脉病变程度的影响。方法选取自2017年2月至2019年2月收治的120例AMI患者为AMI组,患者均存在不同程度的冠状动脉病变;选取同期收治的80例稳定型心绞痛(SAP)患者为SAP组;选取同期体检的72例健康者为健康组。采用实时荧光定量法检测3组血清miR-133a、miR-208a表达水平,并进行比较。对AMI患者行冠状动脉造影,根据Gensini评分明确AMI患者冠状动脉病变程度,并分为轻度、中度、重度,比较不同冠状动脉病变程度的AMI患者血清miR-133a、miR-208a表达水平,采用Pearson线性相关分析对AMI患者血清miR-133a、miR-208a表达水平与冠状动脉病变程度的相关性进行分析。绘制受试者工作特征(ROC)曲线分析血清miR-133a、miR-208a对冠状动脉病变加重的评估价值。采用Logistic回归分析对AMI患者冠脉病变加重的危险因素进行分析。结果AMI组、SAP组的血清miR-133a、miR-208a相对表达量高于健康组,且AMI组高于SAP组,差异均有统计学意义(P<0.05)。重度、中度病变患者血清miR-133a、miR-208a相对表达量均高于轻度病变患者,且重度病变患者高于中度病变患者,差异均有统计学意义(P<0.05)。经Pearson线性相关分析显示,血清miR-133a、miR-208a与AMI冠状动脉病变程度呈正相关(r=0.729、r=0.680,P<0.05)。以中度、重度患者为冠状动脉病变加重,ROC曲线显示,血清miR-133a、miR-208a及二者联合评估冠脉病变加重的ROC曲线下面积分别为0.751、0.774、0.854。Logistic回归分析结果显示,糖尿病、高血压以及血清miR-133a、miR-208a表达水平增高是AMI冠脉病变加重的危险因素(P<0.05)。结论血清miR-133a、miR-208a在AMI患者中表达明显增高,且与冠状动脉病变密切相关,二者联合检测对冠状动脉病变程度具有一定预测价值。

Objective To investigate the expression levels of microRNA(miR)-133a and miR-208a in serum of elderly patients with acute myocardial infarction(AMI),and analyze their influence on the severity of coronary artery disease.Methods A retrospective study was performed on 120 cases of patients with AMI who were admitted from February 2017 to February 2019,all patients had different severity of coronary artery disease;80 cases of stable angina pectoris(SAP)patients in the same period were selected as SAP group;72 cases of healthy people in the same period were selected as the healthy group.The expression levels of miR-133a and miR-208a in serum of the 3 groups were measured by real-time fluorescence quantitative method and compared.Coronary angiography was performed on patients with AMI.According to Gensini score,the severity of coronary artery lesion was defined and divided into mild,moderate and severe.The expression levels of serum miR-133a and miR-208a in patients with different severity of coronary artery disease were compared.Pearson linear correlation analysis was used to analyze the correlation between the levels of serum miR-133a and miR-208a and the severity of coronary artery disease.The receiver operating characteristic(ROC)curve was drawn to analyze the evaluation value of serum miR-133a and miR-208a for the aggravation of coronary artery disease.Logistic regression analysis was used to analyze the risk factors of coronary artery lesion aggravation in AMI patients.Results The relative expression levels of serum miR-133a and miR-208a in AMI group and SAP group were higher than those in healthy group,and the AMI group was higher than that in SAP group,with statistically significant differences(P<0.05).The relative expression levels of miR-133a and miR-208a in serum of patients with severe and moderate lesions were all higher than those with mild lesions,and those with severe lesions were higher than those with moderate lesions(P<0.05).Pearson linear correlation analysis showed that serum miR-133a and miR-208a were positively correlated with the degree of coronary artery lesions of AMI(r=0.729,r=0.680,P<0.05).According to the ROC curve,the areas under the ROC curve of serum miR-133a,miR-208a and the combination of the two to evaluate the aggravation of coronary artery disease were 0.751,0.774 and 0.854,respectively.The results of Logistic regression analysis showed that diabetes mellitus,hypertension,and increased serum miR-133a and miR-208a expression levels were risk factors for the aggravation of coronary artery lesions in AMI(P<0.05).Conclusion Serum miR-133a and miR-208a were significantly increased in AMI patients and were closely related to coronary artery disease.Combined detection of the two has certain predictive value for the severity of coronary artery disease.