血清微小RNA-335、微小RNA-193b水平与冠心病患者冠状动脉旁路移植术治疗预后的相关性

Correlation between serum levels of microRNA-335 and microRNA-193b and prognosis of coronary artery bypass grafting in patients with coronary heart disease

目的探讨冠心病(CHD)患者冠状动脉旁路移植术(CABG)治疗后血清微小RNA(miR)-335、miR-193b水平与预后的关系。方法选取阜外华中心血管病医院2018年6月至2020年6月收治的106例CHD患者作为研究对象,全部患者均行CABG治疗,术后进行为期12个月的随访,根据患者预后情况(是否发生不良心血管事件)分为预后不良组和预后良好组。检测并比较两组入院时血清miR-335、miR-193b水平,经Logistic回归、ROC曲线分析入院时血清miR-335、miR-193b水平对CHD患者CABG治疗预后的关系。结果 106例CHD患者经CABG治疗、随访后,有34例发生不良心血管事件,占32.08%;预后不良组胆固醇(TC)、甘油三脂(TG)水平高于预后良好组[(6.02±0.87) mmol/L比(4.45±0.62) mmol/L、(1.87±0.40) mmol/L比(1.53±0.31) mmol/L],miR-335、miR-193b水平低于预后良好组(0.55±0.29比0.81±0.27、0.46±0.25比(0.76±0.24),差异有统计学意义(t=10.577、4.940、4.571、5.869,P<0.05);组间其他资料对比,差异无统计学意义(P>0.05);经单项Logistic回归分析后,将P值放宽至<0.1,纳入符合条件的因素,建立多项Logistic回归模型,结果显示,TC[B=3.666,比值比(OR)=39.106,95%可信区间(CI):8.551~178.831]、TG(B=2.888,OR=17.959,95%CI:4.516~71.423)过表达可能作为CHD患者CABG治疗预后的风险因子(P<0.05),miR-335(B=-3.324,OR=0.036,95%CI:0.007~0.190)、miR-193b(B=-5.068,OR=0.006,95%CI:0.001~0.054)水平高表达可能作为CHD患者CABG治疗预后的保护因子(OR<1,P<0.05);绘制ROC曲线,结果显示,入院时血清miR-335、miR-193b水平预测CHD患者CABG治疗预后不良的AUC均>0.70,具有一定预测价值,且以入院时血清miR-335、miR-193b的截点(cut-off)值取0.640、0.660时,可获得最佳预测价值。结论血清miR-335、miR-193b水平与CHD患者CABG治疗预后密切相关,两者联合检测有利于预测CHD患者预后。

Objective To explore the relationship between serum microRNA(miR)-335 and miR-193b levels and prognosis in patients with coronary heart disease(CHD)after coronary artery bypass grafting(CABG).Methods 106 patients with CHD admitted to Central China Fuwai Hospital,Zhengzhou University from June 2018 to June 2020 were selected as the research subjects,all patients were treated with CABG,the patients were followed up for 12 months after operation,according to the prognosis of patients(whether adverse cardiovascular events occurred),they were divided into a poor prognosis group and a good prognosis group.The serum levels of miR-335 and miR-193b at admission were detected and compared between the two groups,the relationship between the serum levels of miR-335 and miR-193b at admission and the prognosis of patients with CHD after CABG was analyzed.Results Among 106 patients with CHD after CABG treatment and follow-up,34 cases had adverse cardiovascular events,accounting for 32.08%;the levels of cholesterol(TC)(6.02±0.87)mmol/L,triglyceride(TG)(1.87±0.40)mmol/L in poor prognosis group were higher than those in good prognosis group(4.45±0.62)mmol/L,(1.53±0.31)mmol/L,and the levels of miR-335(0.55±0.29),miR-193b(0.46±0.25)were lower than those in good prognosis group(0.81±0.27),(0.76±0.24),the differences were statistically significant(t=10.577,4.940,4.571,5.869,P<0.05);there was no statistical significant difference in other data between the two groups(P>0.05);after the single Logistic regression analysis,the P value was relaxed to<0.1,the eligible factors were included,and the multiple logistic regression model was established,the results showed that the overexpression of TC(B=3.666,odds ratio(OR)=39.106,95%confidence interval(CI):8.551-178.831),TG(B=2.888,OR=17.959,95%CI:4.516-71.423)might be a risk factor for the prognosis of patients with CHD after CABG(OR>1,P<0.05),the high expression of miR-335(B=-3.324,OR=0.036,95%CI:0.007-0.190),miR-193b(B=-5.068,OR=0.006,95%CI:0.001-0.054)levels might be a protective factor for the prognosis of patients with CHD after CABG(OR<1,P<0.05);the ROC curve was drawn,and the results showed that the area under curve(AUC)of serum miR-335 and miR-193b levels at admission in predicting poor prognosis of patients with CHD after CABG treatment were all>0.70,which had certain predictive value,when the cut-off values of serum miR-335 and miR-193b at admission were 0.640 and 0.660,the best predictive value could be obtained.Conclusion The serum levels of miR-335 and miR-193b are closely related to the prognosis of patients with CHD after CABG,the combined detection of the two is helpful to monitor the prognosis of patients with CHD.