血浆微小核糖核酸-21对急性心肌梗死患者心肌缺血程度及预后的评估价值分析  

Value of plasma microRNA-21 level in prediction of myocardial ischemia degree and evaluation of prognosis in patients with acute myocardial infarction

作　　者：张骁 宗刚军 沈沁 ZHANG Xiao;ZONG Gangjun;SHEN Qin(Cardiovascular Department of Internal Medicine,the 904th Hospital of the Joint Logistics Support Force of the Chinese People′s Liberation Army,Wuxi,Jiangsu,214000)

机构地区：[1]中国人民解放军联勤保障部队第九〇四医院心血管内科,江苏无锡214000

出　　处：《实用临床医药杂志》2021年第18期97-101,106,共6页Journal of Clinical Medicine in Practice

基　　金：江苏省科学技术厅自然科学基金(BK20201139)。

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。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 in

关 键 词：微小核糖核酸-21 SYNTAX评分 急性心肌梗死 心肌缺血 近期预后 

分 类 号：R542.2[医药卫生—心血管疾病] R540.4[医药卫生—内科学]