血清miR-124、CD146及Angptl2水平与急性脑梗死患者颈动脉粥样硬化斑块稳定性的关系研究

Relationship between serum levels of miR-124,CD146 and Angptl2 and the stability of carotid atherosclerotic plaque in patients with acute cerebral infarction

目的探讨血清微小RNA-124(miR-124)、CD146、血管生成素样蛋白2(Angptl2)与急性脑梗死(ACI)患者颈动脉粥样硬化(CAS)斑块稳定性的关系,为ACI患者的早期防治提供参考依据。方法选择2020年1月至2023年2月在邯郸市中心医院就诊的ACI患者191例作为ACI组,另选取同期在该院体检的健康志愿者61例作为对照组。根据颈动脉彩色多普勒超声结果将ACI患者分为不稳定斑块组(56例)、稳定斑块组(71例)、无斑块组(64例)。采用实时荧光定量聚合酶链式反应(RT-qPCR)技术检测所有对象血清miR-124表达水平,采用酶联免疫吸附试验(ELISA)检测血清CD146、Angptl2水平,采用单因素及多因素Logistic回归分析ACI患者CAS斑块不稳定的影响因素;采用受试者工作特征(ROC)曲线分析血清miR-124、CD146联合Angptl2对ACI患者CAS斑块不稳定的预测价值。结果ACI组血清CD146、Angptl2水平高于对照组,miR-124表达水平低于对照组(P<0.05)。单因素分析结果显示,ACI患者CAS斑块的稳定性与患者年龄、合并高血压、合并高脂血症、纤维蛋白原(FIB)、血清C反应蛋白(CRP)、血清胱抑素C(CyC)、CD146、Angptl2、miR-124有关(P<0.05);多因素Logistic回归分析结果显示,血清miR-124下降、CD146升高、Angptl2升高、合并高脂血症是ACI患者CAS斑块稳定性的危险因素(P<0.05)。血清miR-124、CD146、Angptl2及三项指标联合应用预测ACI患者CAS斑块不稳定的ROC曲线下面积(AUC)分别为0.741、0.719、0.781和0.834。结论血清miR-124表达水平及CD146、Angptl2水平是ACI患者CAS斑块不稳定的影响因素,可能参与ACI患者CAS斑块形成及发展过程,三者联合检测对ACI患者CAS斑块不稳定具有较好的预测效能。

Objective To explore the relationship between serum microRNA-124(miR-124),CD146,angiopoietin-like protein 2(Angptl2)and the stability of carotid atherosclerosis(CAS)plaque in patients with acute cerebral infarction(ACI),and to provide reference for early prevention and treatment of patients with ACI.Methods A total of 191 patients with ACI admitted in Handan Central Hospital from January 2020 to February 2023 were selected as ACI group,and another 61 healthy volunteers who were underwent physical examination during the same period were selected as control group.The patients with ACI were divided into unstable plaque group(56 cases),stable plaque group(71 cases),and non plaque group(64 cases)based on carotid color doppler ultrasound results.The serum miR-124 expression levels of all subjects were detected by real time fluorescence quantitative polymerase chain reaction(RT-qPCR),and the serum CD146 and Angptl2 levels were detected by enzyme-linked immunosorbent assay(ELISA).The influencing factors of the instability of CAS plaque in patients with ACI was analyzed by univariate and multivariate Logistic regression.The predictive value of serum miR-124,CD146 combined with Angptl2 for the instability of CAS plaque in patients with ACI was analyzed by the receiver operating characteristic(ROC)curve.Results The serum CD146 and Angptl2 levels in ACI group were higher than those in control group(P<0.05),and the miR-124 expression level was lower than that in control group(P<0.05).Univariate analysis showed that the stability of CAS plaques in ACI patients was correlated with age,hypertension,hyperlipidemia,fibrinogen(FIB),serum C-reactive protein(CRP),serum cystatin C(CyC),CD146,Angptl2 and miR-124(P<0.05).Multivariate Logistic regression analysis showed that the decrease of serum miR-124,the increase of CD146,the increase of Angptl2 and the combination of hyperlipidemia were risk factors for CAS plaque stability in ACI patients(P<0.05).The area under ROC curve(AUC)of serum miR-124,CD146,Angptl2 and the combination of the three indicators to predict CAS plaque instability in ACI patients were 0.741,0.719,0.781 and 0.834,respectively.Conclusion The serum miR-124 expression level,CD146 and Angptl2 levels are the influencing factors of CAS plaque instability in ACI patients,which may be involved in the formation and development of CAS plaque in ACI patients.The combined detection of the three factors has a good predictive effect on CAS plaque instability in ACI patients.