血清miR-140-5p和SFRP-5对糖尿病合并冠心病患者PCI术后支架内再狭窄的预测价值

Prognostic values of serum miR-140-5p and SFRP-5 for in-stent restenosis in diabetes patients combined with coronary heart disease after percutaneous coronary intervention

目的 探究血清微小核糖核酸(miR)-140-5p和分泌型卷曲蛋白-5(SFRP-5)对糖尿病合并冠心病患者经皮冠状动脉介入治疗(PCI)术后支架内再狭窄(ISR)的预测价值。方法 回顾性分析我院2021年5月至2022年5月收治的糖尿病合并冠心病PCI术后患者125例,根据随访12个月后的冠状动脉造影(CAG)结果将其分为ISR组(n=41)和非ISR组(n=84),比较2组以及不同病情程度患者的血清miR-140-5p和SFRP-5的表达水平,并绘制ROC曲线分析血清二者对PCI术后ISR的预测价值,同时分析影响PCI术后ISR的相关危险因素。结果 ISR组的血清miR-140-5p、SFRP-5均显著低于非ISR组(P<0.01);糖尿病病情轻度组的血清miR-140-5p、SFRP-5均显著高于重度组(P<0.01);冠脉病变轻度组的血清miR-140-5p、SFRP-5均显著高于中度组和重度组,且中度组高于重度组(P<0.01);ROC曲线显示,血清miR-140-5p、SFRP-5及二者联合预测PCI术后ISR的敏感度分别为80.87%、84.24%、94.17%,特异度分别为70.33%、82.17%、89.52%,AUC分别为80.87、84.24、94.17(P<0.01),miR-140-5p的最佳截断值为0.91 ng/mL,SFRP-5为33.82μg/L;Logistic回归分析结果显示,有冠心病家族史、LDL-C和HbA1c水平升高、收缩压和舒张压水平升高、支架数目≥3个、支架直径<3 mm、存在串联支架均是PCI术后ISR的危险因素(P<0.05),而服用依洛尤单抗、SFRP-5、miR-140-5p水平升高是PCI术后ISR的独立保护因素(P<0.05)。结论 血清miR-140-5p、SFRP-5与冠心病合并糖尿病患者的病情严重程度具有一定相关性,且二者联合检测对PCI术后ISR的发生具有较高的预测价值,对其进行动态监测有助于预防ISR发生。

Objective To investigate the predictive values of serum microRNA-140-5p(miR-140-5p) and secreted frizzled related protein 5(SFRP-5) for in-stent restenosis(ISR) in diabetes patients combined with coronary heart disease after percutaneous coronary intervention(PCI).Methods A total of 125 diabetes patients combined with coronary heart disease after PCI admitted to our hospital from May 2021 to May 2022 were retrospectively recruited.According to the results of coronary angiography(CAG) after 12 months of follow-up,patients were assigned into ISR group(41 cases) and non-ISR group(84 cases).Expression levels of serum miR-140-5p and SFRP-5 were compared between the two groups and patients with varying severities.Receiver operating characteristic(ROC) curves were drawn to analyze the predictive value of serum miR-140-5p and SFRP-5 in ISR after PCI,and the related risk factors affecting ISR after PCI were analyzed.Results Serum miR-140-5p and SFRP-5 in ISR group were significantly lower than those of non-ISR group(all P<0.01).Serum miR-140-5p and SFRP-5 in mild diabetes group were significantly higher than those of severe diabetes group(all P<0.01).Serum miR-140-5p and SFRP-5 in mild coronary disease group were significantly higher than those of moderate and severe groups,which were significantly higher in moderate coronary disease group than the severe coronary disease group(all P<0.01).ROC curves showed that the sensitivity of serum miR-140-5p,SFRP-5 and their combination in predicting ISR after PCI was 80.87%,84.24% and 94.17%,respectively,and the specificity was 70.33%,82.17% and 89.52%,respectively(all P<0.01).The area under the curve(AUC) of serum miR-140-5p,SFRP-5 and their combination was 80.87,84.24 and 94.17,respectively(all P<0.01).The optimal cut-off values for miR-140-5p and SFRP-5 were 0.91 ng/mL and 33.82 μg/L,respectively.Logistic regression analysis showed that family history of coronary heart disease,elevated levels of low-density lipoprotein cholesterol(LDL-C) and hemoglobin A1C(HbA1c),elevated levels of systolic and diastolic blood pressure,number of stents ≥3,stent diameter < 3mm,and presence of series stents were all risk factors for ISR after PCI(all P<0.05).Use of itolizumab,and increased levels of SFRP-5 and miR-140-5p were independent protective factors for ISR after PCI(all P<0.05).Conclusion Serum miR-140-5p and SFRP-5 have a certain correlation with the severity of coronary heart disease combined with diabetes,and their combined detection has a high predictive value for the occurrence of ISR after PCI.Dynamic monitoring of miR-140-5p and SFRP-5 is helpful to prevent the occurrence of ISR.