血清外泌体miR-23b对STEMI患者行PCI后发生院内主要不良心血管事件的预测价值

Predictive value of serum exosomal miR-23b to nosocomial major adverse cardiovascular events in STEMI patients after percutaneous coronary intervention

目的研究血清外泌体miR-23b对ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠脉介入术(PCI)后发生院内主要不良心血管事件(MACE)的预测价值。方法选取2019年5月至2020年5月于海南医学院第一附属医院行直接PCI的STEMI患者103例,在入院时(PCI前)及术后1 d内(≤24 h)、2~3 d(48~72 h)、4~7 d时采集血液样本。根据是否发生院内MACE,分为MACE组和非MACE组。另外随机选择48例健康志愿者作为对照。采用实时定量聚合酶链反应(RT-qPCR)检测血清外泌体miR-23b表达。结果与健康志愿者相比,STEMI患者PCI前血清外泌体miR-23b相对表达量升高(1.31±0.42 vs.1.00±0.11,P<0.05)。对于STEMI患者,PCI后1 d内(≤24 h)外泌体miR-23b相对表达量达到峰值,随后逐渐降低。采用重复测量设计的方差分析,MACE组和非MACE组患者外泌体miR-23b相对表达量在不同时间点比较、组间比较以及变化趋势比较均存在统计学差异(F时间=114.108,F组别=51.905,F组别×时间=21.152,P<0.05)。ROC曲线分析发现,PCI后1 d内血清外泌体miR-23b预测STEMI患者行PCI术后短期发生MACE的AUC[0.923(95%CI:0.876~0.980)]最高(P<0.001);而且经多因素Logistic回归分析,PCI术后1 d内血清外泌体miR-23b表达量升高是STEMI患者PCI后发生MACE的独立预测因素(P<0.05)。结论血清外泌体miR-23b对STEMI患者行PCI后发生院内MACE具有良好的预测价值。

Objective To study the predictive value of serum exosomal miR-23b to incidence of nosocomial major adverse cardiovascular events(MACE)in STEMI patients after percutaneous coronary intervention(PCI).Methods STEMI patients undergone PCI(n=103)were chosen from the First Affiliated Hospital of Hainan Medical College from May 2019 to May 2020.The blood samples were collected respectively at admission time(before PCI),within 1 d after PCI(≤24 h),and after PCI for 2~3 d(48~72 h)and 4~7 d.According to incidence of nosocomial MACE,the patients were divided into MACE group and non-MACE group.In addition,healthy volunteers(n=48)were chosen randomly as controls.The expression of serum miR-23b was detected by using RT-qPCR.Results The expression of serum miR-23b increased in STEMI patients compared with controls(1.31±0.42 vs.1.00±0.11,P<0.05)before PCI.The expression of miR-23b reached peak within 1 d(≤24 h)after PCI and then decreased gradually in STEMI patients.The results of repeated detection ANOVA showed that comparisons in miR-23b expressions between MACE group and non-MACE group at different time points and in tendency changes all had statistical differences(Ftime=114.108,Fgroups=51.905,Fgroups×time=21.152,P<0.05).The results of ROC curve analysis showed that AUC of miR-23b in predicting MACE occurred in a short term after PCI was the highest[0.923(95%CI:0.876~0.980),P<0.001]in STEMI patients.The results of multi-factor Logistic regression analysis showed that increase of miR-23b expression within 1 d after PCI was an independent predictive factor in STEMI patients after PCI(P<0.05).Conclusion Serum exosomal miR-23b has a higher predictive value to incidence of nosocomial MACE in STEMI patients after PCI.