血清miR-499联合PLTP水平对不停跳冠状动脉旁路移植术后心房颤动的预测价值  

Fibrillation after Off-Pump Isolated Coronary Artery Bypass Grafting

作　　者：王春丽 王凤丹 周敏 方垂璧 孙骁 WANG Chunli;WANG Fengdan;ZHOU Min(The Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 201900,China)

机构地区：[1]上海交通大学医学院附属第九人民医院心脏外科,上海201900

出　　处：《河北医学》2023年第8期1292-1298,共7页Hebei Medicine

基　　金：上海市卫生健康委员会卫生行业临床研究项目,(编号:20194Y0112)。

摘　　要：目的:探讨血清微小RNA-499(miR-499)联合磷脂转移蛋白(PLTP)水平对不停跳冠状动脉旁路移植术(OPCABG)后心房颤动(AF)的预测价值。方法:选取2018年1月至2022年6月我院收治的237例接受OPCABG术的冠心病患者,根据OPCABG术后是否发生AF分为AF组69例和非AF组168例。采用qPCR和酶联免疫吸附法检测血清miR-499与PLTP水平。采用Spearman相关性分析OPCABG后AF患者血清miR-499与PLTP水平的相关性,采用多因素Logistic回归分析OPCABG后AF的影响因素,采用ROC曲线分析血清miR-499、PLTP水平对OPCABG后AF的预测价值。结果:AF组血清miR-499水平(1.53±0.29)高于非AF组(1.22±0.33),PLTP水平[1.36(1.00,2.01)]低于非AF组[2.33(1.39,3.53)],差异有统计学意义(t/Z=6.731、5.879,P均<0.001)。Spearman相关性分析显示,OPCABG后AF患者血清miR-499与PLTP水平呈负相关(rs=-0.789,P<0.001)。多因素Logistic回归分析显示,年龄(OR=1.085,95%CI:1.036~1.136)、糖尿病(OR=3.399,95%CI:1.472~7.853)、左心房内径(OR=1.194,95%CI:1.063~1.341)、miR-499(OR=2.961,95%CI:1.944~4.508)为OPCABG后AF的独立危险因素,PLTP(OR=0.319,95%CI:0.195~0.522)为独立保护因素(P<0.05)。ROC曲线分析显示,血清miR-499联合PLTP水平(AUC=0.842,95%CI:0.789~0.886)预测OPCABG后AF的AUC大于miR-499(AUC=0.759,95%CI:0.699~0.812)、PLTP(AUC=0.743,95%CI:0.683~0.798)单独预测(Z=3.154、3.804,P均<0.05)。结论:血清miR-499水平升高和PLTP水平降低与OPCABG后AF独立相关,血清miR-499联合PLTP水平预测OPCABG后AF的价值较高。Objective:To investigate the predictive value of serum microRNA-499(miR-499)combined with phospholipid transfer protein(PLTP)levels on atrial fibrillation(AF)after off-pump isolated coronary artery bypass grafting(OPCABG).Methods:A total of 237 patients with coronary artery disease who underwent OPCABG admitted to our hospital from January 2018 to June 2022 were selected and divided into 69 cases in the AF group and 168 cases in the non-AF group according to whether AF occurred after OPCABG.Serum miR-499 and PLTP levels were measured by qPCR and ELISA.Spearman correlation was used to analyze the correlation between serum miR-499 and PLTP levels in patients with AF after OPCABG,multi-factor logistic regression was used to analyze the factors influencing AF after OPCABG,and ROC curve was used to analyze the predictive value of serum miR-499 and PLTP levels on AF after OPCABG.Results:Serum miR-499 levels were higher in the AF group(1.53±0.29)than in the non-AF group(1.22±0.33),and PLTP levels[1.36(1.00,2.01)]were lower than in the non-AF group[2.33(1.39,3.53)],with statistically significant differences(t/Z=6.731,5.879,all P<0.001).Spearman correlation analysis showed that serum miR-499 was negatively correlated with PLTP levels in AF patients after OPCABG(rs=-0.789,P<0.001).Multifactorial logistic regression analysis showed that age(OR=1.085,95%CI:1.036 to 1.136),diabetes(OR=3.399,95%CI:1.472 to 7.853),left atrial diameter(OR=1.194,95%CI:1.063 to 1.341)and miR-499(OR=2.961,95%CI:1.944 to 4.508)were independent risk factors for AF after OPCABG and PLTP(OR=0.319,95%CI:0.195 to 0.522)was an independent protective factor(P<0.05).ROC curve analysis showed that serum miR-499 combined with PLTP levels(AUC=0.842,95%CI:0.789 to 0.886)predicted a greater AUC for AF after OPCABG than miR-499(AUC=0.759,95%CI:0.699 to 0.812),PLTP(AUC=0.743,95%CI:0.683 to 0.798)predicted individually(Z=3.154,3.804,all P<0.05).Conclusion:Increased serum miR-499 levels and decreased PLTP levels were independently associated with post-OPCABG AF,an

关 键 词：不停跳冠状动脉旁路移植术 微小RNA-499 磷脂转移蛋白 心房颤动 预测 

分 类 号：R654.2[医药卫生—外科学]