急性心肌梗死患者血清miR-133a、miR-499-5p表达与PCI术后冠状动脉无复流的关系  

Relationship between serum miR-133a,miR-499-5p expression in patients with acute myocardial infarction and no coronary reflow after PCI

作　　者：余琴[1] 梁丽艳[1] 刘超群[1] 方志敏[1] 若扎 YU Qin;LIANG Liyan;LIU Chaoqun;FANG Zhimin;RUO Zha(Department of Cardiovascular Medicine,Second Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang 830063,China)

机构地区：[1]新疆医科大学第二附属医院心血管内科,新疆乌鲁木齐830063

出　　处：《国际检验医学杂志》2023年第9期1059-1063,共5页International Journal of Laboratory Medicine

基　　金：新疆医科大学科研创新基金项目(XYDCX201650)。

摘　　要：目的探讨急性心肌梗死(AMI)患者血清微小核糖核酸(miR)-133a、miR-499-5p表达及其与AMI患者经皮冠状动脉介入(PCI)术后冠状动脉无复流的关系。方法选取2019年2月至2021年10月该院收治的290例接受PCI治疗的AMI患者作为研究对象。依据PCI术后3个月患者冠状动脉血流情况分为无复流组[心肌梗死溶栓治疗(TIMI)分级1~2级]、复流正常组(TIMI 3级)。分析术前血清miR-133a、miR-499-5p表达与AMI患者PCI术后无复流的关系。结果随访3个月后,290例AMI患者PCI术后TIMI分级1~2级66例,3级224例;冠状动脉无复流发生率为22.76%(66/290)。无复流组发病至PCI时间长于复流正常组,术前白细胞计数(WBC)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、miR-133a、miR-499-5p表达水平高于复流正常组,差异均有统计学意义(P<0.05).Logistic回归分析结果显示,发病至PCI时间长,以及术前WBC、CK-MB、cTnI、miR-133a、miR-499-5p高是AMI患者PCI术后血流TIMI分级低的危险因素(OR>1,P<0.05);受试者工作特征(ROC)曲线分析结果显示,术前血清miR-133a、miR-499-5p及二者联合预测AMI患者PCI术后冠状动脉无复流的曲线下面积(AUC)为0.727、0.697、0.773,具有一定的预测价值;决策曲线分析结果显示,在高风险阈值0.00~1.00范围内血清miR-133a、miR-499-5p联合预测AMI患者PCI术后冠状动脉无复流的净收益率>0,有临床意义。结论AMI患者PCI术前血清miR-133a、miR-499-5p水平与术后冠状动脉无复流有关。Objective To investigate the expression of serum microRNA(miR)-133a and miR-499-5p in patients with acute myocardial infarction(AMI)and their relationship with the absence of coronary reflow after percutaneous coronary intervention(PCI).Methods A total of 290 AMI patients treated with PCI from February 2019 to October 2021 were selected as the study subjects.According to the coronary blood flow condition 3 months after PCI,patients were divided into no reflow group(TIMI grade 1-2)and normal reflow group(TIMI grade 3).The relationship between the expression of serum miR-133a and miR-499-5p before surgery and the absence of coronary reflow after PCI in AMI patients was analyzed.Results After 3 months of follow-up,there were 18 cases of grade 1,48 cases of grade 2,and 224 cases of grade 3 TIMI in 290 AMI patients after PCI.The incidence of non-recurrent coronary artery was 22.76%(66/290).Compared with normal reflow group,the time from onset to PCI in non reflow group was longer,and the WBC and expression levels of CK-MB,cTnI,miR-133a and miR-499-5p were higher,with statistical significance(P<0.05).Logistic regression analysis showed that long time from onset to PCI and high preoperative WBC,CK-MB,cTnI,miR-133a and miR-499-5p were risk factors for low blood flow TIMI grading in AMI patients after PCI(OR>1,P<0.05).Receiver operating characteristic(ROC)curve analysis results showed that preoperative serum miR-133a,miR-499-5p and their combination predicted the area under the curve(AUC)of AMI patients without coronary reflow after PCI were 0.727,0.697,0.773,which had certain predictive value.The results of decision curve analysis showed that in the high-risk threshold range of 0.00-1.00,the combination prediction of serum miR-133a and miR-499-5p for the net benefit rate of AMI patients with no coronary reflow after PCI was over 0,which had clinical significance.Conclusion The levels of serum miR-133a and miR-499-5p before PCI in AMI patients are related to no coronary reflow after PCI.

关 键 词：急性心肌梗死 经皮冠状动脉介入 冠状动脉无复流 miR-133a miR-499-5p 

分 类 号：R542.22[医药卫生—心血管疾病]