血清miR-130a、miR-449a对冠心病患者接受经皮冠状动脉介入术后发生支架内再狭窄的预测价值

Value of serum miR-130a and miR-449a levels for predicting in-stent restenosis after coronary intervention in patients with coronary heart disease

目的探讨微小RNA-130a(miR-130a)和微小RNA-449a(miR-449a)对冠心病患者接受经皮冠状动脉介入术(PCI)后发生支架内再狭窄(ISR)的预测价值。方法选取2019年10月至2022年10月在该院确诊为冠心病并接受PCI的90例患者作为研究对象,PCI后对其进行6个月的随访,根据患者是否发生ISR分为ISR组和非ISR组,收集整理临床资料。采用荧光定量聚合酶链反应检测两组血清miR-130a、miR-449a水平;采用多因素Logistic回归分析影响冠心病患者接受PCI后发生ISR的因素;采用受试者工作特征(ROC)曲线评价血清miR-130a、miR-449a水平预测冠心病患者接受PCI后发生ISR的效能。结果随访6个月后,发生ISR 17例,未发生ISR 73例。ISR组血清miR-130a水平明显高于非ISR组,miR-449a水平明显低于非ISR组,差异均有统计学意义(P<0.05)。ISR组和非ISR组的年龄、性别、体质量指数、吸烟史、高血压病史及甘油三酯、高密度脂蛋白胆固醇、糖化血红蛋白水平比较,差异均无统计学意义(P>0.05);ISR组总胆固醇、低密度脂蛋白胆固醇及总胆红素水平明显高于非ISR组,差异均有统计学意义(P<0.05)。不同病变部位、病变类型、支架大小的ISR患者血清miR-130a和miR-449a水平比较,差异均无统计学意义(P>0.05),不同狭窄支数、病变长度的ISR患者血清miR-130a和miR-449a水平比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,miR-130a、总胆固醇、低密度脂蛋白胆固醇、总胆红素水平升高均是冠心病患者接受PCI后发生ISR的独立危险因素(P<0.05),miR-449a水平升高是PCI后发生ISR的独立保护因素(P<0.05)。ROC曲线分析结果显示,血清miR-130a、miR-449a单项及二者联合检测预测冠心病患者PCI后发生ISR的曲线下面积(AUC)分别为0.805、0.889、0.967,二者联合检测预测ISR的AUC明显大于miR-130a、miR-449a单独检测(Z=2.239,P=0.025;Z=2.266,P=0.024)。结论miR-130a、miR-449a水平与冠心病患者接受PCI后发生ISR关系密切,且miR-130a、miR-449a联合检测对冠心病患者接受PCI后发生ISR具有较高的临床预测价值。

Objective To investigate the value of the serum levels of microRNA-130a(miR-130a),microRNA-449a(miR-449a)for predicting in-stent restenosis(ISR)after percutaneous coronary intervention(PCI)in patients with coronary heart disease.Methods A total of 90 patients diagnosed with coronary heart disease and underwent PCI in Ziyang Central Hospital from October 2019 to October 2022 were selected as the research objects.They were followed up for 6 months after PCI.According to whether ISR occurred,the patients were divided into ISR group and non-ISR group,and their clinical data were collected.The serum levels of miR-130a and miR-449a in the two groups were detected by fluorescence quantitative polymerase chain reaction.Multivariate Logistic regression was used to analyze the factors affecting ISR in patients with coronary heart disease after PCI.The receiver operating characteristic(ROC)curve was used to evaluate the efficacy of serum miR-130a and miR-449a levels in the prediction of ISR in patients with coronary heart disease after PCI.Results After 6 months of follow-up,there were 17 cases of ISR and 73 cases of non-ISR.The level of serum miR-130a in ISR group was significantly higher than that in non-ISR group,and the level of miR-449a was significantly lower than that in non-ISR group,the differences were statistically significant(P<0.05).There was no significant difference on age,gender,body mass index,smoking history,and levels of hypertension,triglyceride,high-density lipoprotein cholesterol,glycosylated hemoglobin between ISR group and non-ISR group(P>0.05).The levels of total cholesterol,low-density lipoprotein cholesterol and total bilirubin in ISR group were significantly higher than those in non-ISR group,the differences were statistically significant(P<0.05).There was no significant difference on the serum levels of miR-130a and miR-449a in ISR patients with different lesion location,lesion type and stent size(P>0.05),but there were significant differences on the serum levels of miR-130a and miR-449a in ISR patients with different stenosis number and lesion length(P<0.05).The results of multivariate Logistic regression analysis showed that the increased levels of miR-130a,total cholesterol,low-density lipoprotein cholesterol and total bilirubin were independent risk factors for ISR in patients with coronary heart disease after PCI(P<0.05),the increased level of miR-449a was an independent protective factor for ISR in patients with coronary heart disease after PCI(P<0.05).The results of ROC curve analysis showed that the area under the curve(AUC)of serum miR-130a,miR-449a levels and their combination in the prediction of ISR in patients with coronary heart disease after PCI were 0.805,0.889,0.967 respectively.The AUC of combined detection of miR-130a and miR-449a in the prediction of ISR was significantly higher than that of miR-130a or miR-449a alone(Z=2.239,P=0.025;Z=2.266,P=0.024).Conclusion The levels of miR-130a and miR-449a relate closely to the occurrence of ISR in patients with coronary heart disease after PCI,and the combination of miR-130a and miR-449a has high clinical prediction value for ISR in patients with coronary heart disease after PCI.