急性冠脉综合征患者血浆LncRNA NEAT1、LMR水平变化及其临床意义

Changes and clinical significance of plasma LncRNA NEAT1 and LMR levels in patients with acute coronary syndrome

目的探讨血浆长链非编码RNA核内富集转录物1(LncRNA NEAT1)、淋巴细胞/单核细胞比值(LMR)与急性冠脉综合征(ACS)的相关性。方法选取2021年1月至2022年1月因胸闷胸痛等胸前区不适症状在娄底市中心医院心血管内科住院行冠状动脉造影术检查的194例患者作为研究对象。其中,冠状动脉造影检查阴性(冠状动脉造影检查显示冠状动脉正常)共50例,纳入对照组;其余144例冠状动脉造影检查阳性的患者(即ACS患者)根据诊断标准分为不稳定型心绞痛(UA)组(n=64)和急性心肌梗死(AMI)组(n=80)。用实时定量PCR检测各组血浆中LncRNA NEAT1的表达水平;检测并收集血常规淋巴细胞计数(LC)和单核细胞计数(MC)并计算出LMR水平。采用Spearman分析LncRNA NEAT1、外周血LMR、Gensini积分和肌钙蛋白I(TnI)的相关性;通过ROC曲线评估血浆LncRNA NEAT1、LMR对ACS的诊断效能。结果三组患者的吸烟史比较,差异有统计学意义(P<0.05),其中AMI组的有吸烟史率高于对照组,差异有统计学意义(P<0.017);AMI组的肌酸激酶同工酶(CK-MB)、TnI水平、Gensini积分高于对照组及UA组,差异有统计学意义(P<0.05)。AMI组的LncRNA NEAT1表达水平[1.85(1.45,2.31)]高于对照组[0.80(0.35,1.03)]、UA组[1.26(0.69,1.38)],UA组的LncRNA NEAT1表达水平高于对照组,差异有统计学意义(P<0.05)。AMI组的LMR水平(3.59±1.42)低于对照组(4.97±1.50)、UA组(4.63±1.45),差异有统计学意义(P<0.05)。相关性分析结果显示,LncRNA NEAT1与TnI呈正相关(r=0.684,P<0.001),LMR与TnI呈负相关(r=-0.317,P<0.05);LncRNA NEAT1与LMR呈负相关(r=-0.297,P<0.05);LncRNA NEAT1与Gensini积分呈正相关(r=0.654,P<0.001),LMR与Gensini积分呈负相关(r=-0.393,P<0.001)。ROC分析结果显示,血浆LncRNA NEAT1诊断ACS的AUC为0.855(95%CI:0.773~0.936,P<0.001),敏感度和特异度分别为76.4%和88.0%;LMR诊断ACS的AUC为0.684(95%CI:0.561~0.807,P<0.001),敏感度和特异度分别为84.7%和48.0%。结论血浆LncRNA NEAT1表达水平、LMR均与ACS及冠状动脉病变严重程度有关,可能可以作为潜在生物标志物辅助诊断ACS,并判断冠状动脉的病变严重程度。

Objective To investigate the correlation between plasma long non-coding RNA nuclear enriched abundant transcript 1(LncRNA NEAT1),lymphocyte to monocyte ratio(LMR)and acute coronary syndrome(ACS).Methods A total of 194 patients who were hospitalized in the Department of Cardiology,Loudi Central Hospital due to chest tightness and chest pain and underwent coronary angiography from January 2021 to January 2022 were selected as the research objects.Among them,50 cases with negative coronary angiography(coronary angiography showed normal coronary artery)were included in the control group.The remaining 144 patients with positive coronary angiography(ACS patients)were divided into unstable angina pectoris(UA)group(n=64)and acute myocardial infarction(AMI)group(n=80)according to the diagnostic criteria.The expression level of LncRNA NEAT1 in plasma was detected by real-time PCR.The lymphocyte count(LC)and monocyte count(MC)of blood routine were detected and collected,and the LMR level was calculated.Spearman correlation analysis was used to analyze the correlation between LncRNA NEAT1,peripheral blood LMR,Gensini score and troponin I(TnI).ROC curve was used to evaluate the diagnostic efficacy of plasma LncRNA NEAT1 and LMR for ACS.Results There were statistically significant differences in smoking history among the three groups(P<0.05),and the rate of smoking history in AMI group was higher than that in control group,and the difference was statistically significant(P<0.017).The levels of creatine kinase isoenzyme MB(CK-MB),TnI and Gensini score in AMI group were higher than those in control group and UA group,and the differences were statistically significant(P<0.05).The expression level of LncRNA NEAT1 in the AMI group(1.85[1.45,2.31])was higher than that in the control group(0.80[0.35,1.03])and UA group(1.26[0.69,1.38]),and the expression level of LncRNA NEAT1 in the UA group was higher than that in the control group,and the differences were statistically significant(P<0.05).The level of LMR in AMI group(3.59±1.42)was lower than that in control group(4.97±1.50)and UA group(4.63±1.45),and the differences were statistically significant(P<0.05).Correlation analysis showed that LncRNA NEAT1 was positively correlated with TnI(r=0.684,P<0.001),and LMR was negatively correlated with TnI(r=-0.317,P<0.05).LncRNA NEAT1 was negatively correlated with LMR(r=-0.297,P<0.05).LncRNA NEAT1 was positively correlated with Gensini score(r=0.654,P<0.001),and LMR was negatively correlated with Gensini score(r=-0.393,P<0.001).ROC analysis showed that the AUC of plasma LncRNA NEAT1 for ACS diagnosis was 0.855(95%CI:0.773-0.936,P<0.001),and the sensitivity and specificity were 76.4%and 88.0%,respectively.The AUC of LMR in the diagnosis of ACS was 0.684(95%CI:0.561-0.807,P<0.001),and the sensitivity and specificity were 84.7%and 48.0%,respectively.Conclusion Plasma LncRNA NEAT1 expression level and LMR are both associated with the severity of ACS and coronary artery lesions,which may be used as potential biomarkers to assist the diagnosis of ACS and determine the severity of coronary artery lesions.