Value of plasma microRNA-21 level in prediction of myocardial ischemia degree and evaluation of prognosis in patients with acute myocardial infarction
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摘要:目的 探讨血浆微小核糖核酸-21(miRNA-21)水平评估急性心肌梗死(AMI)患者心肌缺血严重程度及预后的临床价值。方法 选取150例急性ST段抬高型心肌梗死患者作为研究对象，根据心肌缺血严重程度将患者分为轻度组(SYNTAX评分 < 23分)58例、中度组(SYNTAX评分23~32分)48例和重度组(SYNTAX评分>32分)44例。比较3组治疗前后血浆miRNA-21、生化指标水平以及Gensini评分。采用Pearson直线相关分析评估血浆miRNA-21与Gensini评分、SYNTAX评分的相关性。随访1年，依据主要不良心血管事件(MACE)随访结果将患者分为非MACE组108例和MACE组42例，比较上述临床指标的差异。采用多元Logistic回归分析评估上述指标与预后的相关性。应用受试者工作特征(ROC)曲线分析血浆miRNA-21水平对AMI患者预后的诊断性能。结果 中度组的血浆miRNA-21、Gensini评分及SYNTAX评分均低于重度组但高于轻度组，差异有统计学意义(P < 0.05)。3组低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、餐后2 h血糖(2 hPBG)、空腹血糖(FBG)、同型半胱氨酸(Hcy)水平比较，差异均有统计学意义(P < 0.05); 3组间凝血酶原时间(PT)、国际标准化比率(INR)比较，差异无统计学意义(P>0.05)。血浆miRNA-21水平与Gensini评分、SYNTAX评分呈正相关(r=0.823、0.784, P=0.029、0.033)。随访1年, MACE组的血浆miRNA-21水平高于非MACE组，差异有统计学意义(P < 0.001)。血浆miRNA-21水平、Gensini评分与SYNTAX评分是AMI患者随访1年预后的影响因素(OR=3.656、2.887、2.913, P=0.013、0.036、0.029)。血浆miRNA-21截断值3.25预测AMI患者随访1年MACE发生的曲线下面积为0.824, 灵敏度为83.9%, 特异度为87.6%(P=0.023)。结论 血浆miRNA-21能有效评估AMI患者心肌缺血严重程度，对近期预后有较好的预测价值。Abstract:Objective To explore the clinical value of the plasma microRNA-21(miRNA-21) level in prediction of myocardial ischemia degree and evaluation of prognosis in patients with acute myocardial infarction (AMI).Methods A total of 150 patients with acute ST-segment elevation myocardial infarction were selected as study objects, and were divided into mild group (58 cases, SYNTAX scores≤22), moderate group (48 cases, SYNTAX scores ranging from 23 to 32) and severe group (44 cases, SYNTAX scores ≥33) according to the myocardial ischemia degree. The plasma levels of miRNA-21, biochemistry indexes and Gensini scores were compared among three groups before and after treatment. The correlations between plasma miRNA-21 level and the Gensini scores, SYNTAX scores were analyzed by Pearson linear correlation analysis. After follow-up for one year, the patients with AMI were divided into non-MACE group (108 cases) and MACE group (42 cases) based on the major adverse cardiovascular events (MACE) of follow-up results. The above indexes were compared between two groups. Multiple Logistic regression analysis was used to evaluate the correlations between the above indicators and prognosis. The diagnostic performance of plasma miRNA-21 level in AMI patients was analyzed by receiver operating characteristic (ROC) curve.Results The plasma levels of miRNA-21, Gensini and SYNTAX scores in the moderate group were lower than the severe group, but higher than the mild group (P < 0.05). The levelsof low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), 2 h postprandial blood glucose (2 hPBG), fasting blood glucose (FBG), homocysteine (Hcy) levels showed significant differences among three groups (P < 0.05), but the levels of prothrombin time (PT) and international standardized ratio (INR) showed no significant differences among three groups (P>0.05). Plasma miRNA-21 level was positively correlated with Gensini score and SYNTAX score (r=0.823, 0.784, P=0.029, 0.033). The plasma level of miRNA-21 in the MACE group was higher than in the non-MACE group (P < 0.001). The index of miRNA-21, Gensini and SYNTAX scores were the risk factors of prognosis after one-year follow-up in patients with AMI (OR=3.656, P=0.013; OR=2.887, P=0.036; OR=2.913, P=0.029). When the cut-off value of plasma miRNA-21 was 3.25, the area under the curve was 0.824, the sensitivity was 83.9%, and the specificity was 87.6% (P=0.023).Conclusion The plasma levels of miRNA-21 can evaluate the myocardial ischemia degree of patients with AMI, and has good predictive value on the short-term prognosis.
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Keywords:
- miRNA-21 /
- SYNTAX score /
- acute myocardial infarction /
- myocardial ischemia /
- short-term prognosis
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表 1 3组一般资料比较(x±s)[n(%)]
组别 n 年龄/岁 性别 BMI/(kg/m2) 吸烟史 饮酒史 家族史 高血压病史 糖尿病史 男 女 轻度组 58 39.6±12.9 32(55.2) 26(44.8) 20.8±2.0 28(48.3) 24(41.4) 30(51.7) 32(55.2) 23(39.7) 中度组 48 42.5±10.5 28(58.3) 20(41.7) 21.9±1.7 25(52.1) 22(45.8) 27(56.3) 28(58.3) 20(41.7) 重度组 44 40.8±11.8 25(56.8) 19(43.2) 21.2±1.3 24(54.5) 22(50.0) 26(59.1) 26(59.1) 19(43.2) BMI: 体质量指数。 
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表 2 3组患者相关临床指标水平比较(x±s)
指标 轻度组(n=58) 中度组(n=48) 重度组(n=44) F/χ2 P miRNA-21 1.4±0.3 3.0±1.0 4.9±1.1 4.176 0.002 Gensini评分/分 39.8±9.3 65.5±19.8 81.8±10.5 3.724 0.016 SYNTAX评分/分 20.8±5.4 26.9±3.7 36.1±1.9 3.125 0.040 LDL-C/(mmol/L) 2.0±0.7 2.3±0.7 2.5±0.8 3.011 0.046 HDL-C/(mmol/L) 1.0±0.2 0.9±0.2 0.8±0.1 3.064 0.043 2 hPBG/(mmol/L) 9.3±2.4 10.5±2.0 11.3±2.8 3.276 0.032 FBG/(mmol/L) 6.3±1.3 6.8±1.7 7.1±2.3 3.172 0.038 PT/s 10.8±2.0 10.2±2.2 9.8±1.8 1.505 0.221 INR 0.6±0.2 0.6±0.4 0.5±0.3 1.871 0.132 Hcy/(μmol/L) 17.0±2.2 18.3±2.6 19.4±2.9 3.564 0.025 miRNA-21: 微小核糖核酸-21; LDL-C: 低密度脂蛋白胆固醇; HDL-C: 高密度脂蛋白胆固醇; 2 hPBG: 餐后2 h血糖; FBG: 空腹血糖; PT: 凝血酶原时间; INR: 国际标准化比值; Hcy: 同型半胱氨酸。
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表 3 AMI患者血浆miRNA-21水平与Gensini评分、SYNTAX评分的相关性分析
指标 血浆miRNA-21水平 r P Gensini评分 0.823 0.029 SYNTAX评分 0.784 0.033
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表 4 MACE组与非MACE组相关临床指标水平比较(x±s)
组别 n miRNA-21 Gensini评分/分 SYNTAX评分/分 MACE组 42 4.6±1.3* 75.7±12.3* 30.1±5.6* 非MACE组 108 1.9±0.7 50.8±8.4 23.9±7.4 miRNA-21: 微小核糖核酸-21; MACE: 主要不良心血管事件。与非MACE组比较, *P < 0.05。
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表 5 AMI患者预后影响因素的多元Logistic回归分析
检测指标 回归系数β S. E. Wald OR P 95%CI LDL-C 0.218 0.177 1.521 1.244 0.088 0.896~1.504 HDL-C 0.439 0.283 2.405 1.551 0.071 0.927~2.038 2 hPBG 0.709 0.422 2.819 2.031 0.062 1.214~2.925 FBG 0.886 0.512 2.996 2.426 0.058 1.589~3.261 Hcy 0.704 0.408 2.974 2.031 0.059 1.725~2.386 血浆miRNA-21 1.296 0.483 7.204 3.656 0.013 2.867~4.460 Gensini评分 1.060 0.498 4.532 2.887 0.036 2.295~3.512 SYNTAX评分 1.069 0.462 5.356 2.913 0.029 2.462~3.423
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