摘要
目的 探讨急性冠脉综合征(ACS)患者血清micro RNA(mi R)-93-5p预测经皮冠状动脉介入术(PCI)后冠状动脉支架内再狭窄(ISR)及预后的价值。方法 2018年1月1日至2021年3月31日期间接受药物洗脱支架(DES)植入术的544例ACS患者被纳入研究。在PCI术后6~18个月,通过冠状动脉定量分析评估ISR,并进一步将患者分为ISR组(n=54)和非ISR组(n=490)。采用实时荧光定量PCR法检测基线血清mi R-93-5p表达水平。结果 ISR组患者血清mi R-93-5p水平显著高于非ISR组[2.06(1.22,3.03)vs. 0.87(0.53,1.90),Z=-6.091,P <0.001]。Logistic回归分析显示,血清mi R-93-5p水平是ISR的独立危险因素之一(P <0.05)。血清miR-93-5p水平预测ACS患者DES植入术后ISR发生的受试者操作特征(ROC)曲线下面积为0.758(95%CI:0.717~0.799),对应截断值为1.042,灵敏度为84.3%,特异度为61.8%。经Spearman秩相关系数法分析,ISR患者血清mi R-93-5p水平与N末端B型脑钠肽(rs=0.636,P <0.001)、C反应蛋白(rs=0.413,P=0.002)呈正相关,与左室射血分数(rs=-0.279,P=0.041)呈负相关。随访1年,高血清mi R-93-5p水平与更高的主要心血管不良事件的发病率相关(34.1%vs. 10.9%,P <0.001),这也得到Kaplan-Meier生存分析的证实(log rank=21.192,P <0.001)。结论较高的血清miR-93-5p水平预示着ACS患者冠状动脉ISR风险较高,且预后更差。
Objective To investigate the value of serum miRNA(miR)-93-5p in predicting in-stent restenosis(ISR)and prognosis in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods A total of 544 ACS patients who received drug eluting stents(DES)implantation in our hospital from January 1,2018 to March 31,2021 were included in the study.ISR was assessed by coronary quantitative analysis 6-18 months after implantation of DES.Patients were divided into ISR group(n=54)and non-ISR group(n=490)according to whether or not ISR was detected.The expression level of serum miR-93-5p was detected by real-time fluorescence quantitative PCR.Results The level of serum miR-93-5p in ISR group was significantly higher than that in non-ISR group[2.06(1.22,3.03)vs.0.87(0.53,1.90),Z=-6.091,P<0.001].Logistic regression analysis showed that serum miR-93-5p level was one of the independent risk factors for ISR(P<0.05).The area under ROC curve for predicting ISR in ACS patients after DES implantation was 0.758(95%CI:0.717-0.799),the corresponding cut-off value was 1.042,the sensitivity was 84.3%,and the specificity was 61.8%.By Spearman rank correlation coefficient analysis,the serum miR-93-5p level in ISR patients was positively correlated with N-terminal pro-brain natriuretic peptide(r s=0.636,P<0.001)and C-reactive protein(r s=0.413,P=0.002),but negatively correlated with left ventricular ejection fraction(r s=-0.279,P=0.041).During 1-year follow-up,high serum miR-93-5p level was associated with a higher incidence rate of major cardiovascular adverse events(34.1%vs.10.9%,P<0.001),which was also confirmed by Kaplan-Meier survival analysis(log rank=21.192,P<0.001).Conclusion Higher serum miR-93-5p levels indicate a higher risk of coronary ISR and a worse prognosis in ACS patients.
作者
郭宏毅
汤祥瑞
袁鹰
GUO Hongyi;TANG Xiangrui;YUAN Ying(Department of Cardiovascular Medicine,3201 Hospital Affiliated to Medical College of Xi'an Jiaotong University,Hanzhong 723000,Shaanxi,China)
出处
《中国分子心脏病学杂志》
CAS
2023年第4期5513-5519,共7页
Molecular Cardiology of China
基金
陕西省自然科学基金资助项目(97SM38)。
