冠心病合并慢性心力衰竭患者血清miR-133a表达与冠状动脉病变程度的相关性

Correlation between serum miR-133a expression and severity of coronary artery disease in patients with coronary heart disease complicated with chronic heart failure

目的:探讨冠心病合并慢性心力衰竭(CHF)患者血清微小RNA-133a(miR-133a)表达水平与冠状动脉病变程度的相关性。方法:选取102例冠心病合并CHF患者为研究对象,根据Gensini评分分为冠脉轻度狭窄组(<30分,n=56)和冠脉重度狭窄组(≥30分,n=46);根据冠状动脉病变支数分为单支组(n=45)、双支组(n=39)和三支组(n=18)。比较不同冠脉狭窄程度组患者C反应蛋白(CRP)、D-二聚体、N末端脑钠肽前体(NT-proBNP)、左室射血分数(LVEF)和miR-133a水平及冠脉不同病变支数组患者miR-133a水平,分析miR-133a水平与冠状动脉病变程度的相关性及对重度冠脉狭窄的诊断价值。结果:重度狭窄组患者NT-proBNP、CRP、D-二聚体及血清miR-133a水平均高于轻度狭窄组(P<0.05);冠脉不同病变支数组患者血清miR-133a水平比较,差异有统计学意义(P<0.05),且三支病变组>双支病变组>单支病变组(P<0.05)。相关性分析显示,血清miR-133a水平和NT-proBNP是CHF患者冠脉重度狭窄的独立影响因素(P<0.05)。ROC曲线分析显示,miR-133a对重度冠脉狭窄诊断的曲线下面积(AUC)为0.811,大于NT-proBNP的0.676,差异有统计学意义(P<0.05)。结论:CHF患者血清miR-133a水平与冠状动脉病变程度相关,对重度冠脉狭窄有重要诊断价值。

Objective:To investigate the correlation between the expression level of serum microRNA-133a(miR-133a)and the severity of coronary artery disease in patients with coronary heart disease complicated with chronic heart failure(CHF).Methods:102 patients with coronary heart disease complicated with CHF were selected and divided into mild coronary stenosis group(<30 points,n=56)and severe coronary stenosis group(≥30 points,n=46)according to Gensini score.According to the number of coronary artery lesions,they were divided into single branch group(n=45),double branch group(n=39)and three branch group(n=18).The levels of C-reactive protein(CRP),D-dimer,N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular ejection fraction(LVEF)and miR-133a in patients with different degree of coronary artery stenosis and the levels of miR-133a in patients with different number of coronary artery lesions were compared.The correlation between the level of miR-133a and the degree of coronary artery disease and its diagnostic value for severe coronary artery stenosis were analyzed.Results:The levels of NT-proBNP,C-reactive protein,D-dimer and serum miR-133a in severe coronary stenosis group were higher than those in mild coronary stenosis group(P<0.05).The serum miR-133a level of patients with different number of coronary artery lesions was statistically significant(P<0.05),and the level of serum miR-133a in double-vessel disease group and three-vessel disease group was higher than that in single-vessel disease group(P<0.05),and the level of serum miR-133a in three-vessel disease group was higher than that in double-vessel disease group(P<0.05).Logistic regression analysis showed that serum miR-133a level and NT-proBNP were independent influencing factors of severe coronary stenosis in CHF patients(P<0.05).The ROC curve showed that the AUC of miR-133a was 0.811,which was greater than that of NT-proBNP(0.676),and the difference was statistically significant(P<0.05).Conclusion:The level of serum miR-133a in patients with CHF is correlated with the severity of coronary artery stenosis and has important diagnostic value for identifying severe coronary artery stenosis.