探究miR-374a-5p与急性ST段抬高型心肌梗死患者PCI后6个月内支架内血栓形成的关系

Relationship between miR-374a-5p and intrastent thrombosis within 6 months after PCI for patients with ST-segment elevation myocardial infarction

目的探究与分析miR-374a-5p与急性ST段抬高型心肌梗死患者经皮冠状动脉介入术(PCI)后6个月内支架内血栓形成的关系。方法回顾性分析晋城市人民医院2020年4月至2022年3月收治的实施PCI治疗的急性ST段抬高型心肌梗死患者138例的临床资料,按照术后6个月是否出现了支架内血栓形成分为形成组(27例)及未形成组(111例),查阅患者的临床基线资料以及实验室检查指标等,采用单因素及多因素logistic回归分析ST段抬高型心肌梗死患者PCI后6个月内支架内血栓形成的影响因素;采用受试者工作特征曲线(ROC)分析miR-374a-5p在判断ST段抬高型心肌梗死患者PCI后6个月内支架内血栓形成的价值。结果形成组性别、年龄、体质量指数(BMI)、高血压病史、高血脂病史、梗死部位、急诊PCI时间、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、收缩压(SBP)、舒张压(DBP)、血红蛋白(Hb)、血小板计数(PLT)、心率(HR)及左心室射血分数(LVEF)与未形成组相比,差异均无统计学意义(均P>0.05)。与未形成组相比,形成组糖尿病病史比例、多支架置入比例、血清miR-374a-5p水平较高,差异均有统计学意义(均P<0.05)。ROC下面积为0.699,标准误差为0.049,显著性为<0.001,渐进95%置信区间为0.604~0.795,该组患者实施PCI后6个月内发生支架内血栓形成的miR-374a-5p切点为1.115,提示miR-374a-5p具有较好的诊断价值。行logistic回归分析发现,糖尿病病史、多支架置入以及miR-374a-5p可作为ST段抬高型心肌梗死患者PCI后6个月内支架内血栓形成的高危因素(均P<0.05)。结论糖尿病病史、多支架置入以及miR-374a-5p可作为ST段抬高型心肌梗死患者PCI后6个月内支架内血栓形成的高危因素。检测miR-374a-5p水平可辅助评估ST段抬高型心肌梗死患者的预后。

Objective To explore and analyze the relationship between miR-374a-5p and intrastent thrombosis within 6 months after percutaneous coronary intervention(PCI)for patients with ST-segment elevation myocardial infarction.Methods The clinical data of 138 patients with ST-segment elevation myocardial infarction treated by PCI at Jincheng People's Hospital from April 2020 to March 2022 were retrospectively analyzed.According to whether intrastent thrombosis occurred 6 months after the surgery,the patients were divided into a formation group(27 cases)and a non-formed group(111 cases).All the clinical baseline data and laboratory examination indicators were reviewed.The univariate and multivariate logistic regressions were used to analyze the factors of intrastent thrombosis within 6 months after PCI for the patients with ST-segment elevation myocardial infarction.The receiver operating characteristic curve(ROC)was used to analyze the value of miR-374a-5p in determining the intrastent thrombosis within 6 months after PCI for the patients with ST-segment elevation myocardial infarction.Results There were no statistical differences in the gender,age,body mass index(BMI),history of hypertension,history of hyperlipidemia,site of infarction,emergency PCI time,total cholesterol(TC),triacylglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),systolic blood pressure(SBP),diastolic blood pressure(DBP),hemoglobin(Hb),platelet count(PLT),heart rate(HR),and left ventricular ejection fraction(LVEF)between the formation group and the non-formed group(all P>0.05).The proportions of the patients with diabetes history and multiple stentings and the serum miR-374a-5p level in the formation group were higher than those in the non-formed group,with statistical differences(all P<0.05).The area under the ROC was 0.699;the standard error was 0.049;the significance was<0.001;the progressive 95%confidence interval was 0.604-0.795;the miR-374a-5p cut-off point of intrastent thrombosis within 6 months after PCI surgery in the patients was 1.115,indicating that miR-374a-5p had good diagnostic value.Logistic regression analysis showed that history of diabetes,multiple stentings,and miR-374a-5p could be used as risk factors for intrastent thrombosis within 6 months after PCI in the patients with ST-segment elevation myocardial infarction(all P<0.05).Conclusions History of diabetes,multiple stentings,and miR-374a-5p can be used as risk factors for inrastent thrombosis within 6 months after PCI for patients with ST-segment elevation myocardial infarction.The detection of miR-374a-5p level can evaluate the prognosis of patients with ST-segment elevation myocardial infarction.