急性冠状动脉综合征患者血清微小RNA-133a和微小RNA-208a的表达及与冠状动脉病变程度的关系

Expressions of serum microRNA-133a and microRNA-208a in patients with acute coronary syndrome and their relationship with severity of coronary artery lesion

目的探讨急性冠状动脉综合征(ACS)患者血清微小RNA(miR)-133a、miR-208a的表达水平及与冠状动脉病变程度的关系。方法选取2017年2月至2019年2月青海大学附属医院收治的ACS患者120例,冠状动脉轻度病变(SYNTAX评分≤22分)34例、中度病变(SYNTAX评分23~31分)51例、重度病变(SYNTAX评分≥32分)35例,冠状动脉造影为单支病变29例、双支病变35例、3支病变32例、多支病变24例。选取本院同期收治的稳定型心绞痛(SAP)患者60例(SAP组)和体检健康者60名(健康对照组)。比较3组研究对象的基线资料,血清miR-133a和miR-208a水平,不同冠状动脉病变严重程度和病变支数组ACS患者血清miR-133a和miR-208a水平,分析ACS患者血清miR-133a和miR-208a水平与SYNTAX评分、冠状动脉病变支数的相关性,以及血清miR-133a和miR-208a对ACS患者冠状动脉中重度病变的诊断价值。结果ACS组和SAP组血清miR-133a和miR-208a水平均高于健康对照组[(2.49±0.72)、(1.50±0.61)比(1.06±0.58),(0.64±0.15)、(0.32±0.11)比(0.21±0.16)],且ACS组均高于SAP组(均P<0.05)。随着冠状动脉病变程度的加重和冠状动脉病变支数的增加,ACS患者血清miR-133a和miR-208a水平呈逐渐升高趋势(均P<0.05)。ACS患者血清miR-133a和miR-208a与SYNTAX评分均呈正相关(r=0.637、0.702,均P<0.05),与冠状动脉病变支数均呈正相关(rs=0.653、0.691,均P<0.05)。血清miR-133a与miR-208a联合诊断ACS患者冠状动脉中重度病变的曲线下面积高于血清miR-133a和miR-208a单独检测(0.872比0.816、0.805)。结论血清miR-133a和miR-208a在ACS患者中表达上调,并与冠状动脉病变程度密切相关,早期联合检测可作为临床辅助评估ACS病情严重性的生化指标。

Objective To investigate the expression levels of serum microRNA(miR)-133 a and miR-208 a in patients with acute coronary syndrome(ACS)and their relationship with the severity of coronary artery lesion.Methods From February 2017 to February 2019,120 patients with ACS admitted to Qinghai University Affiliated Hospital were selected.There were 34 cases of mild coronary artery lesion(SYNTAX score≤22),51 cases of moderate coronary artery lesion(SYNTAX score 23-31),and 35 cases of severe coronary artery lesion(SYNTAX score≥32).Coronary angiography showed that there were 29 cases of single vessel lesion,35 cases of double vessels lesions,32 cases of three vessels lesions,and 24 cases of multi vessels lesions.Sixty patients with stable angina pectoris admitted to the hospital(SAP group)and 60 healthy people(healthy control group)were selected in the same period.The baseline data,serum miR-133 a and miR-208 a levels were compared among the three groups,and the levels of serum miR-133 a and miR-208 a in ACS patients with different severity and the number of coronary artery lesions were compared.The correlations of serum miR-133 a and miR-208 a levels,SYNTAX score and the number of coronary artery lesion were analyzed.The diagnostic values of serum miR-133 a and miR-208 a in moderate and severe coronary artery lesion in ACS patients were analyzed.Results The serum levels of miR-133 a and miR-208 a in ACS group and SAP group were higher than those in healthy control group[(2.49±0.72),(1.50±0.61)vs(1.06±0.58),(0.64±0.15),(0.32±0.11)vs(0.21±0.16)],and those in ACS group were higher than those in SAP group(all P<0.05).With the severity and the number of coronary artery lesions increasing,the serum levels of miR-133 a and miR-208 a in ACS patients increased gradually(all P<0.05).Serum miR-133 a and miR-208 a were positively correlated with SYNTAX score(r=0.637,0.702,both P<0.05),and positively correlated with the number of coronary artery lesion(rs=0.653,0.691,both P<0.05).The area under curve of combined detection of serum miR-133 a and miR-208 a in patients with ACS was higher than that of serum miR-133 a and miR-208 a alone(0.872 vs 0.816,0.805).Conclusions Expressions of serum miR-133 a and miR-208 a are up-regulated in patients with ACS and are closely related to the severity of coronary artery lesion.Early combined detection can be used as a biochemical index to evaluate the severity of ACS.