心肌梗死患者miR-150、miR-21-5p水平表达变化及其与心室重构、预后的关系分析

Expression Levels of MiR-150 and MiR-21-5p in Patients with Myocardial Infarction and Their Relationship with Ventricular Remodeling and Prognosis

目的探究急性心肌梗死(acute myocaridial infarction,AMI)患者miR-150、miR-21-5p水平表达变化及与心室重构、预后的关系。方法选择2019年7月至2021年7月治疗的120例AMI患者为研究对象(AMI组),另选取同期80健康体检者为对照组,比较2组患者外周血miR-150、miR-21-5p水平及心室重构指标[左室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末内径(left ventricular end-diastolic dimension,LVEDD)、左室收缩末容积(left ventricular end-systolic volume,LVESV)、左心室质量指数(left ventricular mass index,LVMI)],分析miR-150、miR-21-5p与心室重构指标相关性;患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后随访1年,统计不良心血管事件(major adverse cardiac event,MACE)发生情况,并分析MACE影响因素,探究miR-150、miR-21-5p对MACE发生的预测价值;采用Kaplan Meier生存分析探究患者随访期间无新发MACE事件生存情况。结果与对照组相比,AMI组血清miR-150、LVEF明显下降,miR-21-5p、LVEDD、LVESV、LVMI明显升高(P<0.05);Pearson相关性分析显示,AMI患者血清miR-150水平与LVEF呈正相关(P<0.05),与LVEDD、LVESV、LVMI呈负相关(P<0.05);miR-21-5p水平与LVEF呈负相关(P<0.05),与LVEDD、LVESV、LVMI呈正相关(P<0.05)。与无MACE组相比,MACE组LDL-C、CK-MB、LVEDD、LVESV、LVMI、miR-21-5p均升高(P<0.05),LVEF、miR-150均下降(P<0.05);多因素logistic回归分析显示,低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、肌酸激酶同工酶(creatine kinase isoenzyme-MB,CK-MB)、LVEF、LVESV、miR-150、miR-21-5p是AMI患者PCI术后1年内MACE发生的独立影响因素(P<0.05)。miR-150、miR-21-5p预测AMI患者PCI术后MACE发生的受试者工作特征曲线下面积分别为0.869、0.855;Kaplan Meier生存分析显示,随访1年内,miR-150高表达组无新发MACE事件生存情况优于低表达组(P<0.05),miR-21-5p低表达组无新发MACE事件优于高表达组(P<0.05)。结论AMI患者miR-150表达下降、miR-21-5p表达升高,且与患者心室重构、预后密切相关。

Objective To investigate the expression levels of miR-150 and miR-21-5p in patients with acute myocardial infarction(AMI)and their relationship with ventricular remodeling and prognosis.Methods 120 patients with AMI from July 2019 to July 2021 were selected as the research subjects(AMI group),and 80 healthy subjects with physical examination during the same period were enrolled as control group.The levels of peripheral blood miR-150 and miR-21-5p and ventricular remodeling indicators[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic volume(LVESV),left ventricular mass index(LVMI)]were compared between the two groups,and the correlation of miR-150 and miR-21-5p with ventricular remodeling indicators was analyzed.The patients were followed up for 1 year after percutaneous coronary intervention(PCI),and the occurrence of major adverse cardiovascular event(MACE)was counted.The influencing factors of MACE were analyzed to explore the predictive value of miR-150 and miR-21-5p on the occurrence of MACE.Kaplan Meier survival analysis was used to explore the survival status of patients without new-onset MACE events during follow-up.Results Compared with control group,serum miR-150 and LVEF in AMI group were significantly decreased while miR-21-5p,LVEDD,LVESV,and LVMI were significantly increased(P<0.05).Pearson correlation analysis showed that serum miR-150 level in patients with AMI was positively correlated with LVEF,and was negatively correlated with LVEDD,LVESV,and LVMI(P<0.05).miR-21-5p level was negatively correlated with LVEF(P<0.05)and was positively correlated with LVEDD,LVESV,and LVMI(P<0.05).The LDL-C,CK-MB,LVEDD,LVESV,LVMI,and miR-21-5p in MACE group were enhanced(P<0.05)while the LVEF and miR-150 were reduced(P<0.05)compared with those in nonMACE group.Multivariate Logistic regression analysis showed that low-density lipoprotein cholesterol(LDL-C),creatine kinase isoenzyme(CK-MB),LVEF,LVESV,miR-150,and miR-21-5p were independent influencing factors for the occurrence of MACE in patients with AMI within 1 year after PCI(P<0.05).The areas under the receiver operating characteristic curves of miR-150 and miR-21-5p on predicting the occurrence of MACE in patients with AMI after PCI were 0.869 and 0.855 respectively.Kaplan Meier survival analysis showed that within 1 year of follow-up,the survival status of patients without new-onset MACE events in high miR-150 expression group was better than that in low expression group(P<0.05),and the survival status of patients without new-onset MACE events in low miR-21-5p expression group was better than that in high expression group(P<0.05).Conclusion The expression of miR-150 decreases and the expression of miR-21-5p increases in patients with AMI,which are closely related to ventricular remodeling and prognosis of patients.