微小RNA-221和巨噬细胞迁移抑制因子及血栓调节蛋白与心房颤动并缺血性脑卒中的相关性

Relationship of miR-221,MIF and sTM with AF plus ischemic stroke

目的探讨微小RNA221(miR-221)、巨噬细胞迁移抑制因子(MIF)、可溶性血栓调节蛋白(sTM)与非瓣膜性心房颤动(NVAF)合并缺血性脑卒中的相关性及其危险因素。方法选取NVAF患者184例,根据是否合并脑卒中分为脑卒中组63例和NVAF组121例。对比2组血清miR-221、MIF、sTM水平。采用ROC曲线分析血清miR-221、MIF、sTM水平和CHA_(2)DS_(2)-VASc评分对NVAF合并脑卒中患者的预测价值。结果脑卒中组血清MIF、sTM水平明显高于NVAF组,miR-221水平明显低于NVAF组,差异有统计学意义(P<0.01)。Spearman相关性分析显示,NVAF合并脑卒中患者CHA_(2)DS_(2)-VASc评分与MIF、sTM水平呈正相关(r=0.186,P=0.012;r=0.347,P=0.000),与miR-221水平呈负相关(r=-0.261,P=0.000)。多因素logistic回归分析显示,LVEF、miR-221为NVAF合并脑卒中的保护因素,CHA_(2)DS_(2)-VASc评分、MIF、sTM为NVAF合并脑卒中的危险因素(P<0.05,P<0.01)。ROC曲线分析显示,miR-221+MIF+sTM联合预测NVAF合并脑卒中患者的曲线下面积明显大于单独miR-221、MIF、sTM、CHA_(2)DS_(2)-VASc评分(P<0.05,P<0.01)。结论NVAF合并脑卒中患者血清miR-221水平明显降低,MIF、sTM水平明显提升,为合并脑卒中危险因素。

Objective To study the relationship of miR-221,macrophage migration inhibitory factor(MIF)and soluble thrombomodulin(sTM)with NVAF plus ischemic stroke(IS)and the risk factors for NVAF with IS.Methods One hundred and eighty-four NVAF patients were divided into IS group(n=63)and NVAF group(n=121).Their serum levels of miR-221,MIF,sTM were measured and compared.The value of serum miR-221,MIF,sTM for predicting the CHA_(2)DS_(2)-VASc score in NVAF patients with IS was analyzed by ROC curve analysis.Results The serum levels of MIF and sTM were significantly higher while those of miR-221 were significantly lower in IS group than in NVAF group(P<0.01).Spearman correlation analysis showed that the CHA_(2)DS_(2)-VASc score was positively related with the serum levels of MIF and sTM(r=0.186,P=0.012;r=0.347,P=0.000)and negatively related with those of miR-221(r=-0.261,P=0.000)in NVAF patients with IS.Multivariate logistic regression analysis displayed that LVEF and miR-221 were independent protective factors while CHA_(2)DS_(2)-VASc score,serum levels of MIF and sTM were independent risk factors for NVAF with IS(P<0.05,P<0.01).ROC curve analysis revealed that the AUC of miR-221,MIF and sTM in combination for predicting NVAF with IS was significantly larger than that of miR-221,MIF,sTM and CHA_(2)DS_(2)-VASc score alone for predicting NVAF with IS(P<0.05,P<0.01).Conclusion The dereased serum level of miR-221 and increased serum level of MIF and sTM are risk factors for NVAF with IS.