阿托伐他汀诱导EPC-MVs增多对STEMI患者心肌细胞的保护作用研究  

Study on Protective Effect of Atorvastatin-induced Increase of EPC-MVs on Myocardial Cells in STEMI Patients

作　　者：林芸芸[1] 黄珊[2] 宋艳玲[1] 顾申红[1] LIN Yunyun;HUANG Shan;SONG Yanling;GU Shenhong(Dept.of General Medicine,the First Affiliated Hospital of Hainan Medical College,Haikou 570102,China;Dept.of Cardiology,the First Affiliated Hospital of Hainan Medical College,Haikou 570102,China)

机构地区：[1]海南医学院第一附属医院全科医学科,海口570102 [2]海南医学院第一附属医院心内科,海口570102

出　　处：《中国药房》2019年第10期1396-1402,共7页China Pharmacy

基　　金：国家自然科学基金资助项目(No.81560054)

摘　　要：目的:观察阿托伐他汀诱导内皮祖细胞微囊泡(EPC-MVs)增多对ST段抬高型心肌梗死(STEMI)患者心肌细胞的保护作用,并探讨其可能机制。方法:选取2015年2月-2018年2月我院收治的STEMI患者168例,按阿伐他汀剂量分为A组(88例)和B组(94例)。所有患者均接受经皮冠脉介入治疗,术后予注射用比伐芦定、硫酸氢氯吡格雷片、阿托伐他钙片治疗。其中,A组予阿托伐他汀钙片20 mg,每日1次;B组予阿托伐他汀钙片20 mg,每日2次。30 d为1个疗程,两组患者均连续治疗至少3个疗程。观察两组患者血脂[总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]水平(治疗前及治疗后第30、60、90天)和EPCs阳性细胞数(治疗后第30、60天);检测其EPC-MVs微RNA(miRNA)表达谱(治疗后第60天),验证差异表达miRNA的表达情况;分析表达差异最明显miRNA的靶基因及KEGG通路富集情况,并评价其对心肌HCM-a细胞增殖的影响;记录两组患者不良反应发生情况。结果:A组有8例患者脱落,B组有6例患者脱落。治疗前或治疗后30天,两组患者TC、LDL-C、HDL-C水平以及外周血EPCs阳性细胞数比较,差异均无统计学意义(P>0.05);治疗后,两组患者HDL-C水平(治疗后第60、90天)以及B组患者外周血EPCs阳性细胞数(治疗后第60天)均显著升高或增多,且B组显著高于或多于同时间点A组(P<0.05)。芯片检测结果显示,与A组比较,B组患者EPC-MVs中表达差异超过1.5倍的miRNA共有16个,其中7个上调、9个下调;差异表达前5位的分别为hsa-miR-126(上调)、hsa-miR-1275(上调)、hsa-miR-7704(下调)、hsa-miR-105-5p(下调)、hsa-miR-3180(下调)。荧光定量聚合酶链反应结果显示,B组患者hsa-miR-126、hsa-miR-1275的相对表达量均较A组显著升高,hsa-miR-7704、hsa-miR-105-5p、hsa-miR-3180的相对表达量均较A组显著降低(P<0.05)。表达差异最明显的为hsa-miR-126,其靶基因包括Ang-1、PDGF、p38 MAPK、Smad2/3、HIFOBJECTIVE:To observe the protective effect of atorvastatin-induced increase of EPC-MVs on myocardial cells in ST-segment elevation myocardial infarction(STEMI)patients,and to investigate its potential mechanism.METHODS:Totally 168 STEMI patients was collected from our hospital during Feb.2015-Feb.2018,and then divided into group A(88 cases)and group B(94 cases)according to the dose of atorvastatin.All patients received percutaneous coronary intervention,and then given Bivaleridine for injection,Clopidogrel bisulfate tablets and Atorvastatin calcium tablets.Group A was given Atorvastatin calcium tablets 20 mg,once a day.Group B was given Atorvastatin calcium tablets 20 mg,twice a day.A treatment course lasted for 30 d,and two groups were treated for 3 courses at least.The levels of blood lipid(TC,LDL-C,HDL-C)(before treatment and 30th,60th,90th day after treatment)and the number of EPCs positive cells(30th,60th day after treatment)were observed in 2 groups.The expression of miRNA of EPC-MVs(60th day after treatment)was detected,and the expression difference of miRNA were validated.Target gene and KEGG pathway enrichment of miRNA with most significant expression difference were analyzed,and the effects of it on the proliferation of cardiac HCM-a cells were evaluated.The occurrence of ADR was recorded in 2 groups.RESULTS:Totally 8 patients withdrew from the study in group A,and 6 patients in group B.There was no statistical significance in the levels of TC,LDL-C and HDL-C or the number of EPCs positive cells in peripheral blood between 2 groups before treatment or 30th day after treatment(P>0.05).After treatment,the level of HDL-C in 2 group(60th and 90th day after treatment)and the number of EPCs positive cells in peripheral blood in group B(60th day after treatment)were increased significantly,and group B was significantly higher or more than group A at the same time point(P<0.05).Microarray analysis showed that compared with group A,16 miRNAs expressed more than 1.5 times differentially in EPC-MVs of group B,7 of

关 键 词：阿托伐他汀 高密度脂蛋白胆固醇 内皮祖细胞微囊泡 微RNA hsa-miR-126 心肌细胞 增殖 

分 类 号：R453.9[医药卫生—治疗学] R541.4[医药卫生—临床医学]