急性冠状动脉综合征患者PCI治疗前后血清miR-34a、miR-146a水平变化及近期预后预测价值

Changes of serum miR-34a and miR-146a before and after PCI and their short-term prognostic values in ACS patients

目的探讨急性冠脉综合征(acute coronary syndrome,ACS)患者血清微小RNA-34a(miR-34a)、微小RNA-146a(miR-146a)水平变化及近期预后预测价值。方法选取2018年2月~2020年6月收治的拟行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术的ACS患者86例,所有研究对象均采用Judkins法进行冠脉造影,并根据造影图像结果中冠脉血管狭窄程度分为单支病变组(23例),双支病变组(36例),三支病变组(27例);同时对冠脉造影结果进行Gensini评分,<50分为轻度病变组(46例),50~90分为中度病变组(30例),>90分为重度病变组(10例)。采用实时荧光定量聚合酶链式反应(PCR)法检测ACS患者PCI术前、术后1个月的miR-34a、miR-146a的表达水平。并随访ACS患者术后1年内主要不良心血管事件(MACE)的发生情况,并根据是否发生MACE事件分为MACE组与非MACE组,比较两组血清miR-34a、miR-146a的表达水平。结果ACS患者PCI术前血清miR-34a、miR-146a水平明显高于PCI术后(P<0.001);ACS患者冠脉中度病变组血清miR-34a、miR-146a表达水平高于轻度病变组(P<0.001),而重度病变组中血清miR-34a、miR-146a表达水平明显高于中度病变组与轻度病变组(P<0.001);ACS患者冠脉双支病变组血清miR-34a、miR-146a表达水平高于单支病变组(P<0.05);而三支病变组中血清miR-34a、miR-146a表达水平明显高于双支病变组与单支病变组(P<0.05);MACE组患者血清miR-34a、miR-146a表达水平显著高于非MACE组(P<0.001)。结论PCI可明显降低ACS患者体内血清miR-34a、miR-146a的表达水平。而血清miR-34a、miR-146a的表达水平随着冠脉病变程度的加重而增高,故可通过血清miR-34a、miR-146a来预测冠脉的病变程度。同时监测ACS患者PCI术后的血清miR-34a、miR-146a的表达水平也具有重要意义,能预防MACE事件的发生。

Objective To investigate the changes in serum miR-34a and miR-146a levels in patients with acute coronary syndrome(ACS)and the short-term prognostic value of miR-34a and miR-146a levels.Methods 86 ACS patients undergoing percutaneous coronary intervention(PCI)were selected from February 2018 to June 2020.All subjects used Judkins method for coronary angiography,and divided into groups according to the results of the coronary angiography:single-vessel disease group(23 cases),double-vessel disease group(36 cases)and three-vessel disease group(27 cases);simultaneous coronary angiography results for Gensini score,<50 points were mild disease group(46 cases),50~90 points were moderate disease group(30 cases),>90 points were severe disease group(10 cases).Real-time fluorescence quantitative PCR was used to detect the expression levels of miR-34a and miR-146a in ACS patients before PCI and one month after PCI.And follow up the occurrence of major adverse cardiovascular events(MACE)in ACS patients within 1 year after surgery.According to the occurrence of MACE events,the patients were divided into two groups:MACE group and non-MACE group.The expression levels of serum miR-34a and miR-146a were compared between the two groups.Results The serum miR-34a and miR-146a levels of ACS patients before PCI were significantly higher than that after PCI(P<0.001);the expression levels of serum miR-34a and miR-146a in the moderate disease group of ACS patients were higher than those in the mild disease group(P<0.001);while the expression levels of serum miR-34a and miR-146a in the severe disease group were significantly higher than that of the moderate disease group and the mild disease group(P<0.001);the expression levels of serum miR-34a and miR-146a in the doublevessel disease group were higher than those in the single-vessel disease group(P<0.05);the expression levels of serum miR-34a and miR-146a in the three-vessel disease group were significantly higher than those in the double-vessel and single-vessel groups(P<0.05);the expression levels of serum miR-34a and miR-146a in the MACE group were significantly higher than that of patients in the non-MACE group(P<0.001).Conclusion PCI can significantly reduce the serum miR-34a and miR-146a expression levels in ACS patients.The expression levels of serum miR-34a and miR-146a increase with the severity of coronary artery disease.Therefore,serum miR-34a and miR-146a can be used to predict the degree of coronary artery disease.At the same time,monitoring the serum miR-34a and miR-146a expression levels after PCI in ACS patients is also of great significance and can prevent the occurrence of MACE events.