下肢动脉硬化闭塞症患者血浆miR-21、miR-143与术后支架内再狭窄的关系  

Relationship between plasma miR-21,miR-143 and postoperative in-stent restenosis in patients with arteriosclerosis obliterans of lower limbs

作　　者：赵铁军 杨彦冰 申东彦[1] 马腾腾 李静[1] ZHAO Tie-jun;YANG Yan-bing;SHEN Dong-yan;MA Teng-teng;LI Jing(Department of Vascular Surgery,Kaiyuan Branch,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471023,Henan,CHINA)

机构地区：[1]河南科技大学第一附属医院开元院区血管外科,河南洛阳471023

出　　处：《海南医学》2025年第2期159-164,共6页Hainan Medical Journal

基　　金：河南省高等学校重点科研项目计划(编号:21A321073)。

摘　　要：目的探讨下肢动脉硬化闭塞症(LEAOD)患者血浆微小核糖核酸-21(miR-21)、微小核糖核酸-143(miR-143)与术后支架内再狭窄(ISR)的关系。方法前瞻性选择2019年4月至2023年4月于河南科技大学第一附属医院接受支架介入术的178例LEAOD患者纳入研究,检测所有患者术前血浆miR-21、miR-143表达水平及实验室指标。按照术后1年内是否发生ISR分为ISR组53例和非ISR组125例,比较两组患者的血浆miR-21、miR-143表达水平和临床资料,采用多因素Logistic回归模型分析LEAOD患者术后ISR发生的影响因素,采用受试者工作特征(ROC)曲线分析血浆miR-21、miR-143表达及两者联合预测LEAOD患者术后发生ISR的价值。结果ISR组患者的血浆miR-21表达水平为1.87±0.53,明显高于非ISR组的1.32±0.49,血浆miR-143表达水平为0.73±0.37,明显低于非ISR组的1.02±0.29,差异均有统计学意义(P<0.05);ISR组患者的吸烟史占比、糖尿病史占比和低密度脂蛋白水平分别为79.25%、52.83%、(2.89±0.74)mmol/L,明显高于非ISR组的51.20%、38.40%、(2.51±0.72)mmol/L,差异均有统计学意义(P<0.05),但两组患者的性别、Fontaine分期、泛大西洋学会联盟(TASC)Ⅱ分型、血管闭塞位置、高血压史、冠心病史、年龄、空腹血糖、甘油三酯、总胆固醇、高密度脂蛋白水平比较差异均无统计学意义(P>0.05);建立多因素Logistic回归模型发现,糖尿病史、吸烟史、低密度脂蛋白水平、miR-21表达均是LEAOD患者术后发生ISR的危险因素(P<0.05),miR-143表达是保护因素(P<0.05);绘制ROC曲线发现,血浆miR-21、miR-143两者联合预测LEAOD患者术后发生ISR的曲线下面积(AUC)(95%CI)为0.917(0.874~0.960),高于miR-21、miR-143单独预测的0.771(0.695~0.847)、0.730(0.648~0.812),联合预测的敏感度为0.902,特异性为0.865,两者联合优于血浆miR-21、miR-143各自单独预测(P<0.05)。结论LEAOD患者血浆miR-21表达上升、miR-143表达降低会增加术后ISR发生风Objective To investigate the relationship between plasma microRNA-21(miR-21),microRNA-143(miR-143)and postoperative in-stent restenosis(ISR)in patients with lower-extremity arteriosclerosis obliterans(LEAOD).Methods A total of 178 LEAOD patients who underwent stent intervention in the First Affiliated Hospital of Henan University of Science and Technology from April 2019 to April 2023 were prospectively selected.The expression of plasma miR-21 and miR-143 and laboratory indexes were measured before operation.Patients were divided into ISR group(n=53)and non-ISR group(n=125)according to whether ISR occurred within 1 year after surgery.The expression levels of plasma miR-21 and miR-143,clinical data,and laboratory indicators were compared between the two groups.The influencing factors of postoperative ISR in LEAOD patients were analyzed by multivariate logistic regression model.The value of plasma miR-21,miR-143 expression,and the combination of the two indexes for predicting postoperative ISR in LEAOD patients were analyzed by receiver operating characteristic(ROC)curve.Results The expression level of plasma miR-21 in ISR group was 1.87±0.53,which was significantly higher than 1.32±0.49 in non-ISR group,and the expression level of plasma miR-143 was 0.73±0.37,which was significantly lower than 1.02±0.29 in non-ISR group,with statistically significant differences(P<0.05).The proportion of patients with smoking history,proportion of patients with diabetes history,and low density lipoprotein level in ISR group were 79.25%,52.83%,and(2.89±0.74)mmol/L,respectively,which were significantly higher than 51.20%,38.40%,and(2.51±0.72)mmol/L in non-ISR group(P<0.05).However,there was no significant difference in sex,Fontaine stage,TASCⅡclassification,location of vascular occlusion,history of hypertension,history of coronary heart disease,age,fasting blood glucose,triglyceride,total cholesterol,and high density lipoprotein between the two groups(P>0.05).Multivariate logistic regression model showed that diabetes histor

关 键 词：下肢动脉硬化闭塞症 支架内再狭窄 微小核糖核酸-21 微小核糖核酸-143 影响因素 

分 类 号：R543.5[医药卫生—心血管疾病]