循环microRNA-223水平与急性冠脉综合征患者的血小板反应及临床预后相关性的研究  

Correlation research between circulating microRNA-223 and platelet activity and prognosis in patients with acute coronary syndrome

作　　者：张莹莹[1] 郭绪昆[1] 郑君毅[1] 刘婷[2] 张莹[1] 马静[2] 刘寅[1] ZHANG Ying-ying;GUO Xu-kun;ZHENG Jun-yi;LIU Ting;ZHANG Ying;MA Jing;LIU Yin(Department of Cardiology,Tianjin Chest Hospital,Tianjin 300222,China;Tianjin Institute of Cardiovascular Disease)

机构地区：[1]天津市胸科医院心内科,300222 [2]天津市心血管病研究所

出　　处：《天津医药》2021年第3期285-290,共6页Tianjin Medical Journal

摘　　要：目的研究血浆microRNA-223(miR-223)表达水平与急性冠脉综合征(ACS)患者服用氯吡格雷后血小板反应及临床预后的关系。方法连续纳入接受经皮冠状动脉介入治疗(PCI)的ACS患者208例,术前均接受负荷剂量的氯吡格雷+阿司匹林的双联抗血小板聚集治疗(DAPT)。采用实时荧光定量PCR(qPCR)检测血浆miR-223表达水平,流式细胞术检测血小板反应指数(PRI)。根据PRI中位数将患者分为低PRI组(PRI≤56.3%)和高PRI组(PRI>56.3%),各104例。比较2组患者血浆miR-223表达水平和主要临床及生化指标。随访2年,通过Cox比例风险回归分析血浆miR-223表达水平、PRI、肌钙蛋白I(TnI)、B型钠尿肽(BNP)等指标对主要不良心血管事件(MACE)的影响因素。通过受检者工作特征(ROC)曲线评价血浆miR-223、PRI对MACE的预测能力。结果miR-223表达水平与PRI呈负相关(rs=-0.420,P<0.05)。低PRI组患者血浆miR-223表达水平高于高PRI组[(1.15(0.58,1.80)vs.0.64(0.26,1.08),Z=0.471,P<0.05]。30例(14.4%)患者发生MACE,低PRI组MACE发生率低于高PRI组(P<0.05)。Cox比例风险回归分析显示,血浆miR-223和PRI是ACS患者发生MACE的独立预测因子。血浆miR-223和PRI预测ACS患者发生MACE的ROC曲线下面积分别为0.700(95%CI:0.609~0.791,P<0.05)和0.710(95%CI:0.606~0.815,P<0.05)。结论循环miR-223表达水平与ACS患者服用氯吡格雷后PRI呈负相关,循环miR-223和PRI是ACS患者PCI术后MACE的独立预测因子。Objective To investigate the relationship between the expression level of plasma microRNA-223(miR-223)and platelet reactivity as well as clinical prognosis in patients with acute coronary syndrome(ACS)after clopidogrel administration.Methods A total of 208 ACS patients received percutaneous coronary intervention(PCI)were enrolled consecutively.All patients were treated with loading doses of clopidogrel combined with aspirin(DAPT)before intervention.Real-time PCR was used to quantify the expression level of plasma miR-223,and the platelet reactive index(PRI)was quantified through flow cytometry.Patients were divided into two groups according to the PRI median,low PRI group(PRI≤56.3%)and high PRI group(PRI>56.3%),with 104 cases in each group.Plasma miR-223 expression levels,basic clinical data and biochemical index were compared between two groups of patients.After 2-year follow-up,Cox proportional risk regression analysis was used to estimate the influencing factors of plasma miR-223 level,PRI,troponin I(TnI),B-type natriuretic peptide(BNP)and other parameters for major adverse cardiovascular events(MACE).The receiver operating characteristic(ROC)curve was plotted to evaluate the predictive ability of plasma miR-223 and PRI levels for MACE.Results The level of circulating miR-223 was negatively correlated with PRI(rs=-0.420,P<0.05),and miR-223 expression level was significantly higher in low PRI group compared with that of high PRI group[1.15(0.58,1.80)vs.0.64(0.26,1.08),Z=0.471,P<0.05].MACE occurred in 30 patients(14.4%),and the incidence of MACE was lower in low PRI group than that in high PRI group(P<0.05).Cox proportional risk regression analysis showed that the plasma miR-223 level and PRI were independent risk factors for predicting MACE in ACS patients.The AUC of plasma miR-223 and PRI for predicting the occurrence of MACE in ACS patients was 0.700(95%CI:0.609-0.791,P<0.05)and 0.710(95%CI:0.606-0.815,P<0.05),respectively.Conclusion The circulating miR-223 level is negatively correlated with PRI in ACS pat

关 键 词：急性冠状动脉综合征 血小板聚集抑制剂 微RNAS miR-223 氯吡格雷 血小板反应指数 双联抗血小板治疗 

分 类 号：R541.4[医药卫生—心血管疾病]