三种血清微小RNA水平与急性心肌梗死患者术后左心功能和主要不良心血管事件发生的关系

Relationship of serum miR-155,miR-302b and miR-208a levels with left ventricular function and MACE in AMI patients after PCI

目的分析血清微小RNA(micorRNA,miR)-155、miR-302b、miR-208a水平与急性心肌梗死(AMI)患者术后左心功能和主要不良心血管事件(MACE)发生的关系。方法选取2017年8月~2019年8月海南省安宁医院老年病科收治的行PCI的AMI患者242例(试验组),试验组术后随访6个月根据是否发生MACE又分为MACE组75例,非MACE组167例。另选取同期我院健康体检者200例(对照组)。采用实时荧光定量PCR检测入院时血清miR-155、miR-302b、miR-208a水平。采用Pearson相关性分析血清miR-155、miR-302b、miR-208a与入院时左心室质量指数(LVMI)的关系。结果试验组血清miR-155、miR-302b、miR-208a水平及LVMI明显高于对照组(P<0.01)。Pearson相关性分析显示,miR-155、miR-302b、miR-208a水平与LVMI呈正相关(r=0.658,r=0.625,r=0.583,P<0.01)。miR-155预测术后发生左心室重构的曲线下面积为0.746(95%CI:0.704~0.797,P=0.001),最佳截断值为3.85。miR-302b预测术后发生左心室重构的曲线下面积为0.784(95%CI:0.738~0.823,P=0.001),最佳截断值为3.36。miR-208a预测术后发生左心室重构的曲线下面积为0.831(95%CI:0.790~0.875,P=0.001),最佳截断值为1.65。logistic回归分析显示,LVMI、miR-155、miR-302b、miR-208a是AMI患者术后发生MACE的危险因素(P<0.05,P<0.01)。MACE组术前LVMI、miR-155、miR-302b、miR-208a水平明显高于非MACE组(P<0.01)。结论AMI患者术前血清miR-155、miR-302b、miR-208a处于高表达状态,均可作为PCI术后MACE发生的独立危险因素,对术后心室重构具有一定的预测价值。

Objective To analyze the relationship of serum miR-155,miR-302b and miR-208a levels with left ventricular function and MACE in AMI patients after PCI.Methods Two hundred and forty-two AMI patients admitted to our hospital from August 2017 to August 2019 for PCI served as as an experimental group.The patients in experimental group were further divided into MACE group(n=75)and MACE-free group(n=167)after they were followed up for 6 months,and 200 persons who underwent physical examination during the same period served as a control group.Their serum miR-155,miR-302b and miR-208a levels were measured on admission by RT-fluorescence qPCR.The relationship of serum miR-155,miR-302b and miR-208a levels with left ventricular mass index(LVMI)on admission was analyzed by Pearson correlation analysis.Results The serum miR-155,miR-302b and miR-208a levels and LVMI were significantly higher in experimental group than in control group(P<0.01).Pearson correlation analysis showed serum miR-155,miR-302b and miR-208a levels were positively related with LVMI(r=0.658,r=0.625,r=0.583,P<0.01).The AUC for miR-155,miR-302b and miR-208a to predict left ventricular remodeling was 0.746,0.784 and 0.831 respectively with an optimal cut-off value of 3.85,3.36 and 1.65 respectively(95%CI:0.704-0.797,P=0.001;95%CI:0.738-0.823,P=0.001;95%CI:0.790-0.875,P=0.001).Logistic regression analysis showed that LVMI,miR-155,miR-302b and miR-208a were the risk factors for MACE in AMI patients after PCI(P<0.05,P<0.01).Conclusion High serum miR-155,miR-302b and miR-208a levels are the independent risk factors for MACE in AMI patients after PCI,thus having a certain value for predicting ventricular remodeling in AMI patients after PCI.