血清miR-140-3p、sLOX-1对急性STEMI患者PCI术后支架内再狭窄的预测能效

Predictive efficacy of serum miR-140-3p and sLOX-1 to in-stent restenosis in patients with acute STsegment elevation myocardial infarction after PCI

目的探讨血清微小RNA(miR)-140-3p、可溶性凝集素样氧化型低密度脂蛋白受体-1(sLOX-1)对急性ST段抬高型心肌梗死(ASTEMI)患者经皮冠状动脉介入治疗(PCI)术后支架内再狭窄的预测价值。方法选取2019年1月至2021年1月于郑州市第七人民医院心内科收治的247例接受PCI的STEMI患者,根据PCI术后1年是否发生支架内再狭窄分为再狭窄组(n=38)和无再狭窄组(n=209)。收集患者基础资料,RT-PCR测定患者血清miR-140-3p水平,酶联免疫吸附法测定血清sLOX-1水平。分析ASTEMI患者PCI术后支架内再狭窄影响因素,ROC曲线判断血清miR-140-3p、sLOX-1水平对ASTEMI患者PCI术后支架内再狭窄的预测价值。结果与无再狭窄组比较,再狭窄组高密度脂蛋白胆固醇(HDL-C)、左心室射血分数(LVEF)、急诊PCI比例、支架内径及血清miR-140-3p水平降低,空腹血糖(FBG)、超敏C反应蛋白(hs-CRP)、支架长度、Gensini积分及血清sLOX-1水平升高(P<0.05)。多因素Logistics回归分析显示,hs-CRP(OR=2.797,95%CI:1.506~5.194)、急诊PCI(OR=0.186,95%CI:0.106~0.319)、支架内径(OR=0.382,95%CI:0.106~0.319)、miR-140-3p(OR=0.785,95%CI:0.525~0.883)为ASTEMI患者PCI术后支架内再狭窄独立保护因素,Gensini积分(OR=1.228,95%CI:1.086~1.389)、sLOX-1(OR=1.035,95%CI:1.018~1.052)为其独立危险因素(P<0.05)。ROC曲线显示,miR-140-3p联合sLOX-1(AUC=0.892,95%CI:0.847~0.928)预测STEMI患者PCI后支架内再狭窄的AUC明显大于miR-140-3p(AUC=0.791,95%CI:0.735~0.840)、sLOX-1(AUC=0.784,95%CI:0.728~0.834)单独预测,其敏感度、特异度、准确度为81.58%、85.65%、85.02%。结论PCI术后支架内再狭窄ASTEMI患者血清miR-140-3p水平明显降低,sLOX-1水平明显提升,miR-140-3p为PCI术后支架内再狭窄的独立保护因素,sLOX-1为其独立危险因素,二者均对支架内再狭窄具有一定预测价值,联合预测价值更高。

Objective To investigate the predictive value of serum microRNA-140-3p(miR-140-3p)and soluble lectin-like oxidized low density lipoprotein receptor-1(sLOX-1)to in-stent restenosis(ISR)in patients with acute ST-segment elevation myocardial infarction(ASTEMI)after percutaneous coronary intervention(PCI).Methods ASTEMI patients undergone PCI(n=247)were chosen from Department of Cardiology in the Seventh People’s Hospital of Zhengzhou City from Jan.2019 to Jan.2021.All patients were divided,according to whether ISR occurred or not after PCI for 1 y,into ISR group(n=38)and non-ISR group(n=209).The basic materials were collected from the patients.The level of serum miR-140-3p was detected by using RT-PCR,and level of serum sLOX-1 was detected by using ELISA.The influence factors of ISR were analyzed,and predictive value of miR-140-3p and sLOX-1 to ISR was analyzed by using ROC curve in ASTEMI patients after PCI.Results Compared with non-ISR group,levels of high-density lipoprotein-cholesterol(HDL-C)and left ventricular ejection fraction(LVEF),percentage of emergency PCI,stent diameter and miR-140-3p level decreased,and fasting blood glucose(FBG),high-sensitivity C-reactive protein(hs-CRP),stent length,Gensini scores and sLOX-1 level increased in ISR group(P<0.05).The results of multi-factor Logistics regression analysis showed that hs-CRP(OR=2.797,95%CI:1.506~5.194),emergency PCI(OR=0.186,95%CI:0.106~0.319),stent diameter(OR=0.382,95%CI:0.106~0.319)and miR-140-3p(OR=0.785,95%CI:0.525~0.883)were independent protective factors of ISR,and Gensini scores(OR=1.228,95%CI:1.086~1.389)and sLOX-1(OR=1.035,95%CI:1.018~1.052)were independent risk factors of ISR(P<0.05).The results of ROC curve analysis showed that the predictive efficacy of miR-140-3p combined with sLOX-1(AUC=0.892,95%CI:0.847~0.928)was significantly higher than that of miR-140-3p alone(AUC=0.791,95%CI:0.735~0.840)or sLOX-1 alone(AUC=0.784,95%CI:0.728~0.834)in ISR prediction in ASTEMI patients after PCI,and the sensitivity was 81.58%,specificity was 85.65%and accuracy was 85.02%.Conclusion The level of miR-140-3p decreases significantly and sLOX-1 level increases significantly in ASTEMI patients with ISR after PCI.The level of miR-140-3p is an independent protective factor and sLOX-1 level is an independent risk factor of ISR after PCI,and both of them have some predictive value to ISR and miR-140-3p combined with sLOX-1 has a higher predictive value.