微小核糖核酸-590与急性冠状动脉综合征介入术后1年内支架内再狭窄的关系

Relationship between microRNA-590 and in-stent restenosis occurring within one year after PCI in patients with acute coronary syndrome

目的探讨微小核糖核酸-590(miR-590)与急性冠状动脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后1年内支架内再狭窄(ISR)的关系。方法选取2018年2月至2020年1月在重庆市人民医院接受PCI治疗的452例ACS患者作为研究对象。根据术后1年内是否发生ISR,分为ISR组(n=51)和非ISR组(n=401)。实时荧光定量聚合酶链反应(PCR)检测miR-590水平,分析其与ISR的关系。结果ISR组miR-590相对表达量低于非ISR组,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示舒张压(DBP)、空腹血糖(FBG)、低密度脂蛋白胆固醇(LDL-C)和血管病变长度是PCI术后1年内ISR的独立危险因素(P<0.05),miR-590是PCI术后1年内ISR的独立保护因素(P<0.05)。模型Y(由DBP、FBG、LDL-C、血管病变长度和miR-590构成)预测ACS患者PCI术后1年内ISR的ROC曲线下面积高于模型X(由DBP、FBG、LDL-C和血管病变长度构成),差异有统计学意义(P<0.05)。风险阈值为0~0.45或0.80~1.00时,模型Y预测ACS患者PCI术后1年内ISR的净收益高于模型X;风险阈值为0.45~0.80时,模型X预测ACS患者PCI术后1年内ISR的净收益高于模型Y。结论miR-590相对低表达量与ACS患者PCI术后1年内ISR有关。模型X、Y对PCI术后1年内ISR均有一定的预测价值。

Objective To explore the relationship between microRNA-590(miR-590)and in-stent restenosis(ISR)occurring within one year after percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS).Methods A total of 452 patients with ACS,who received PCI at Chongqing Municipal People's Hospital of China between February 2018 and January 2020,were selected as the subjects of this prospective study.According to whether ISR occurred within one year after PCI or not,the patients were divided into ISR group(n=51)and non-ISR group(n=401).Real-time fluorescence quantitative PCR was used to detect the level of miR-590,and its relationship to ISR occurring within one year after PCI in ACS patients was analyzed.Results The relative expression level of miR-590 in ISR group was lower than that in non-ISR group,and the difference was statistically significant(P<0.05).Multivariate logistic regression analysis showed that diastolic blood pressure(DBP),fasting blood glucose(FBG),low density lipoprotein cholesterol(LDL-C)and vascular lesion length were the independent risk factors for ISR within one year after PCI(P<0.05),and miR-590 was an independent protective factor for ISR occurring within one year after PCI(P<0.05).The area under ROC curve of model Y(composed of DBP,FBG,LDL-C,vascular lesion length and mir-590)for predicting ISR occurring within one year after PCI in ACS patients was larger than that of model X(composed of DBP,FBG,LDL-C and vascular lesion length),and the difference between the two models was statistically significant(P<0.05).In predicting ISR occurring within one year after PCI in ACS patients,when the risk threshold of 0-0.45 or 0.80-1 was used,the net benefit of model Y was higher than that of model X.Conclusion A low relative expression level of miR-590 is closely related to ISR occurring within one year after PCI in ACS patients.Both model X and model Y have certain value in predicting ISR occurring within one year after PCI.