他汀类药物对冠心病患者循环微小RNA-92a表达的影响  

The influence of statin therapy on circulating microRNA-92a expression in patients with coronary heart disease

作　　者：王虹[1] 陆红梅[1] 阳文辉[2] 罗程[1] 陆山河[1] 周莹[2] 林英忠[1] 

机构地区：[1]广西壮族自治区人民医院心内科,南宁530021 [2]广西壮族自治区人民医院中心实验室,南宁530021

出　　处：《中国危重病急救医学》2012年第4期215-218,共4页Chinese Critical Care Medicine

基　　金：广西医疗卫生重点科研课题（2010026）

摘　　要：目的探讨他汀类药物对冠心病患者循环微小RNA-92a（miR-92a）的调节作用，评价miR-92a作为新血管内皮损伤治疗靶点的临床应用价值。方法采用病例对照研究方法，分析236例冠心病患者的血脂异常率、他汀类药物治疗率以及治疗后低密度脂蛋白胆固醇（LDL-C）达标率；多因素方差分析他汀类药物治疗对合并2型糖尿病（DM）冠心病患者LDL—C及循环miR-92a表达的影响，比较各组治疗后急性冠脉综合征（ACS）的发生率。结果冠心病非他汀类药物治疗患者LDL—C未达标率高达95．7％（112／117），应获得而未得到他汀类药物治疗者占47．5％（112／236）；他汀类药物治疗者LDL—C达标率为27．7％（33／119）。冠心病他汀类药物治疗组LDL—C（mmol／L）显著低于非治疗组（2．457±0．802比3．218±1．130，z=-9．760，P=0．001），ACS发生率也显著低于非治疗组（33．6％比71．8％，x2=34．491，P=0．001）。在他汀类药物治疗组中，LDL—C达标者与未达标者ACS发生率无明显差异（33．3％比33．7％，×。=0．002，P=0．968）。稳定型心绞痛（SAP）合并DM患者循环miR一92a表达显著高于未合并DM者（0．492比-0．121，z=-3．038，P=0．002）；他汀类药物治疗的SAP合并DM者循环miR-92a表达低于非治疗者（0．419比0．687，z=1．289，P=0．072）；他汀类药物治疗的SAP未合并DM患者与非治疗者循环miR一92a表达差异无统计学意义（-0．032比-0．198，z=-0．614，P=0．539）。多因素方差分析显示：他汀类药物治疗是影响冠心病患者LDL-C水平的主要因素（F=22．863，P=0．001），合并DM是影响SAP患者循环miR-92a表达的主要因素（F=9．641，P=0．003）。结论他汀类药物通过调控循环miR-92a表达，对减轻冠心病患者的血管内皮损伤可能具有临床意义。Objective To investigate the modulatory function of statin therapy on circulating microRNA-92a （miR-92a） in patients with coronary heart disease （CHD）, and to evaluate the possibility of miR-92a as a new target of treatment for endothelial dysfunction. Methods A case control study was conducted. Prevalence of abnormal blood fat content, statin treatment rate, and attainment rate of low density lipoprotein-cholesterol （LDL-C） lowered to expected level in 236 patients with CHD were analyzed. Relationship between statin therapy in patients with type 2 diabetes mellitus （DM）, and level of LDL-C and circulating miR-92a expression was analyzed by multivariate general linear factorial analysis. The incidence of acute coronary syndrome （ACS） was compared in patients with CHD receiving statin therapy in all groups. Results Prevalence of abnormal LDL-C was 95.7% （ 112/117 ） in CHD patients of non-statin therapy group, and 47.5% （112/236） of patients with CHD who should receive statin therapy but did not. Attainment rate of lowering of LDL-C to expected level in statin therapy group was 27.7% （33/119 ）. LDL-C level （mmol/L） was significantly lower in statin therapy group than that in non-statin therapy group （2.457 _＋ 0.802 vs. 3.218 _＋ 1.130, Z= -9.760, P=0.001 ）, and incidence of ACS was significantly lower in statin therapy group than that in non-statin therapy group （33.6% vs. 71.8%, ~5=34.491, P=0.001）. There Was no significant difference in incidence of ACS between patients with or without attaining the expected low value of LDL-C in statin therapy group （33.3% vs. 33.7%, ~2=0.002, P=0.968）. Circulating miR-92a expression was significantly higher in patients with stable angina pectioris （SAP） complicated with DM than those without DM （0.492 vs. -0.121, Z=-3.038, P=0.002）. It was found that statin therapy could down regnlate miR-92a expression in patients with SAP complicated with DM as compared with that with non-statin therapy （0.419 vs. 0.687, Z= 1.289, P

关 键 词：冠心病 他汀类药物 糖尿病 微小RNA-92a 急性冠脉综合征 

分 类 号：R541.4[医药卫生—心血管疾病]