远端肢体缺血预适应对冠心病患者血浆miRNA-21的影响和意义  

Effect of remote ischemic preconditioning on plasma miRNA-21 in patients with coronary heart disease

作　　者：陈云宪 唐良秋[1] 陈兆基[1] 梁家荣[1] 张社兵[1] 范文茂[1] 陈宝峰[1] 陈锦峰[1] Chen Yunxian;Tang Liangqiu;Chen Zhaoji;Liang Jiarong;Zhang Shebing;Fan Wenmao;Chen Baofeng;Chen Jinfeng(Department of Cardiology, Yue Bei People＇s Hospital , Shaoguan 512026, China)

机构地区：[1]粤北人民医院心血管内科,韶关512026

出　　处：《中国心血管杂志》2018年第3期242-246,共5页Chinese Journal of Cardiovascular Medicine

基　　金：韶关市科技局科研项目(2016CX001)~~

摘　　要：目的探讨远端肢体缺血预适应对冠心病患者血浆微小RNA-21(miRNA-21)的影响,进一步阐述缺血预适应的作用机制和临床应用价值。方法连续选择2015年6月至2017年2月在粤北人民医院心内科住院的冠心病心绞痛患者共165例作为研究对象,均行择期经皮冠状动脉介入治疗(PCI),采用随机数字表法分为试验组85例和对照组80例。试验组患者在入院后第2、3和4天的每天上、下午分别进行一轮无创肢体缺血预适应治疗,然后在第5天进行冠状动脉支架置入术;对照组则直接在入院后第5天进行冠状动脉支架置入术。所有患者于入院后第2和5天早晨空腹抽血,检测血浆miRNA-21水平。同时在手术当天早晨及术后12 h抽血检测高敏肌钙蛋白T(hscTnT),以观察手术对其影响。记录手术情况、常规实验室检查结果及6个月内所有不良心血管事件(MACE),并对两组结果进行统计分析。结果 (1)试验组与对照组入院后第2天的血浆miRNA-21水平比较差异无统计学意义(50.82±9.15比51.10±9.56,P>0.05),而第5天的血浆miRNA-21水平比较差异有统计学意义(86.25±12.24比60.52±10.29,t=3.216,P<0.01);试验组第5天的血浆miRNA-21水平较第2天明显上升(t=4.113,P<0.01),而对照组第5天的血浆miRNA-21水平较前无明显变化。(2)试验组PCI术后12 h的hs-c TnT的变化值明显低于对照组水平[(25.27±21.88)pg/ml比(38.79±32.46)pg/ml,t=2.162,P=0.01],此外试验组术中TIMI 3级血流发生率较对照组高(92.9%比85.0%,P=0.04)。(3)试验组共有6例患者在半年内出现MACE,而对照组有9例,差异无统计学意义,但所有出现MACE的患者基线血浆miRNA-21水平明显低于未出现MACE的患者(46.73±10.03比52.12±11.26,t=1.624,P=0.04)。(4)多因素logistic回归分析危险因素对预后的影响,发现基线miRNA-21、左心室射血分数、心功能NYHA分级、冠状动脉病变支数是冠心病患者PCI术后6个月内MACE的独立危险因素。结论远端肢Objective To explore the effect of remote ischemic preconditioning（RIPC） on plasma miRNA-21 in patients with coronary heart disease（CHD）,and further elaborate the mechanism of ischemic preconditioning and its clinical value. Methods A total of 165 patients with CHD patients who were hospitalized in Yuebei people ＇s hospital from June 2015 to February 2017 were selected as the study subjects. All patients underwent elective percutaneous coronary intervention（PCI） and were randomly divided into 80 cases of control group and 85 cases of experimental group. In the second day after admission,the experimental group began to conduct RIPC twice every day for 3 days,and then the PCI was performed on the5 th day. The control group performed PCI on the 5 th day after admission without RIPC. The plasma miR-21 was detected on the 2 nd and 5 th mornings after admission. cT n T was detected on the morning of the operation and 12 h after PCI. The operation situation,laboratory test results and all cardiac events within 6 months were recorded. Results No difference in miR-21 level was found in 2 nd day after admission between both groups（50. 82 ± 9. 15 vs. 51. 10 ± 9. 56,P〈0. 05）,while there was significantly difference in5 thdays（86. 25 ± 12. 24 vs. 60. 52 ± 10. 29,t = 3. 216,P〈0. 01）. The plasma miR-21 levels in the experimental group were significantly higher than before（t = 4. 113,P〈0. 01）,while there was no significant change in control group; The hs-cT nT was lower [（25. 27 ± 21. 88） pg/ml vs.（38. 79 ± 32. 46） pg/ml,t =2. 162,P = 0. 01]and the rate of TIMI 3 blood flow was higher（92. 9% vs. 85. 0%,P = 0. 04） in RIPC group than control group; There were 6 patients with MACE in the experimental group,while 9 patients in the control group showed MACE,and the difference was not statistically significant. But baseline plasma miR-21 levels in all MACE patients were significantly lower than those of non-MACE patients（46. 73 ± 10. 03 vs. 52. 12 ±11. 26,t = 1. 624,P = 0. 04）; M

关 键 词：冠状动脉疾病 缺血预处理 微小RNA-21 

分 类 号：R541.4[医药卫生—心血管疾病]