PAI-1、miR-146a、AQP9在急性心肌梗死rt-PA静脉溶栓前后动态变化及与TIMI血流分级的关系  

Dynamic Changes of PAI-1,miR-146a,and AQP9 before and after Acute Myocardial Infarction rt-PA Intravenous Thrombolysis and Their Relationship with TIMI Blood Flow Grade

作　　者：刘东霞[1] 王有余 王茜[1] 吕玉红[1] LIU Dongxia;WANG Youyu;WANG Xi;LV Yuhong(Department of Cardiology,Baoding second central hospital,Baoding 072750,Hebei,China)

机构地区：[1]保定市第二中心医院心内二科,保安市072750

出　　处：《中国分子心脏病学杂志》2022年第3期4674-4681,共8页Molecular Cardiology of China

摘　　要：目的探讨纤溶酶原激活物抑制剂-1(PAI-1)、微小RNA-146a(miR-146a)、水通道蛋白9(AQP9)在急性心肌梗死(AMI)重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓前后动态变化及与AMI溶栓治疗(TIMI)血流分级的关系。方法选取2017年2月至2020年8月我院收治的186例行rt-PA静脉溶栓患者,根据溶栓后TIMI血流分级分为血流正常组(TIMI血流为Ⅲ级,152例)、慢/无复流组(TIMI血流≤Ⅱ级,34例)。比较两组一般资料及溶栓前、溶栓后0.5 h、溶栓后2 h PAI-1、miR-146a、AQP9水平,采用Spearman分析不同时间点各指标与TIMI血流分级的关系,采用Logistic回归方程分析慢/无复流的相关影响因素,采用受试者工作特征(ROC)曲线及曲线下面积(AUC)分析不同时间点各指标预测慢/无复流的效能。结果两组溶栓后0.5 h PAI-1均呈升高趋势,溶栓后2 h血流正常组显著降低,慢/无复流组仍呈升高趋势(P<0.05);两组溶栓后0.5 h、2 h miR-146a、AQP9均呈降低趋势(P<0.05);慢/无复流组溶栓后0.5 h、2 h PAI-1、miR-146a、AQP9高于血流正常组(P<0.05);溶栓前、溶栓后0.5 h、溶栓后2 h PAI-1、miR-146a、AQP9与TIMI血流分级呈负相关(P<0.05);溶栓前、溶栓后0.5 h、溶栓后2 h PAI-1、miR-146a、AQP9均是慢/无复流的相关影响因素(P<0.05);各指标预测慢/无复流的AUC,溶栓后2 h>溶栓后0.5 h>溶栓前,至溶栓后2 h,PAI-1预测慢/无复流的AUC为0.829,miR-146a预测慢/无复流的AUC为0.838,AQP9预测慢/无复流的AUC为0.834;溶栓前、溶栓后0.5 h、溶栓后2 h各指标联合的AUC均大于对应时间点单一指标,且随时间推移呈递增趋势,至溶栓后2 h各指标联合的AUC最大(P<0.05)。结论PAI-1、miR-146a、AQP9在AMI rt-PA静脉溶栓前后呈动态变化,均与TIMI血流分级有关,并是慢/无复流的影响因素,联合检测有望成为预测慢/无复流的潜在生物学标志物。Objective To investigate the dynamic changes of plasminogen activator inhibitor-1(PAI-1),microRNA-146a(miR-146a),aquaporin 9(AQP9)before and after intravenous thrombolysis with recombinant tissue-type plasminogen activator(rt-PA)in acute myocardial infarction(AMI)and the relationship with the thrombolysis in myocardial infarction(TIMI)blood flow classification.Methods From February 2017 to August 2020,186 patients with rt-PA intravenous thrombolysis were selected in our hospital.According to the TIMI blood flow classification after thrombolysis,the patients were divided into normal blood flow group(TIMI blood flow grade III,152 cases)and slow/no reflow group(TIMI blood flow≤grade II,34 cases).The general data and levels of PAI-1,miR-146a and AQP9 before thrombolysis,0.5 h after thrombolysis,and 2 h after thrombolysis were compared between the two groups.Spearman was used to analyze the relationship between each index and TIMI blood flow classification at different time points,and the logistic regression equation was used to analyze the related influencing factors of slow/no reflow.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)were used to analyze the effectiveness of various indicators at different time points in predicting slow/no reflow.Results The PAI-1 in the two groups showed an increasing trend at 0.5 h after thrombolysis,the normal blood flow group decreased significantly 2 h after thrombolysis,and the slow/no-reflow group still showed an increasing trend(P<0.05).The miR-146a and AQP9 showed a decreasing trend at 0.5 h and 2 h after thrombolysis in the two groups(P<0.05).The PAI-1,miR-146a and AQP9 in the slow/no-reflow group were higher than those in the normal blood flow group at 0.5 h and 2 h after thrombolysis(P<0.05).PAI-1,miR-146a,AQP9 were negatively correlated with TIMI blood flow classification before thrombolysis,0.5 h after thrombolysis and 2 h after thrombolysis(P<0.05).PAI-1,miR-146a,and AQP9 before thrombolysis,0.5 h after thrombolysis,and 2 h after thromb

关 键 词：纤溶酶原激活物抑制剂-1 微小RNA-146a 水通道蛋白9 急性心肌梗死 重组组织型纤溶酶原激活剂静脉溶栓 TIMI血流分级 

分 类 号：R542.22[医药卫生—心血管疾病]