急性冠脉综合征患者血清PCSK9、miR-133a与PCI术后慢/无复流的相关性  

Correlation Between Serum PCSK9,miR-133a and Slow/No Reflow After PCI in Patients with Acute Coronary Syndrome

作　　者：张学兵 刘江峰 杜秋波 李学庆 刘园园 ZHANG Xuebing;LIU Jiangfeng;DU Qiubo;LI Xueqing;LIU Yuanyuan(The Affiliated People’s Hospital of Xinxiang Medical College,Xinxiang 453000,China;Fuwai Central China Cardiovascular Hospital,People’s Hospital of Zhengzhou University,Heart Center of Henan People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]新乡医学院附属人民医院,河南新乡453000 [2]阜外华中心血管病医院,郑州大学人民医院,河南省人民医院心脏中心,河南郑州450003

出　　处：《河南医学研究》2025年第5期810-815,共6页Henan Medical Research

基　　金：河南省医学科技攻关计划项目(LHGJ20200084)。

摘　　要：目的探讨急性冠脉综合征(ACS)患者血清前蛋白转化酶枯草溶菌素9(PCSK9)、微小RNA-133a(miR-133a)与直接经皮冠状动脉介入治疗(PCI)术后慢/无复流的关系。方法选取2021年1月至2023年1月于阜外华中心血管病医院行PCI术的156例ACS患者作为研究对象,术后根据心肌梗塞溶栓治疗(TIMI)血流分级将患者分为慢/无复流组(研究组,40例)和正常血流组(对照组,116例),比较两组患者术前血清PCSK9、miR-133a等指标的差异,分析PCSK9、miR-133a与患者PCI术后慢/无复流的关系。结果研究组患者的血清PCSK9、miR-133a、病变血管数、冠脉支架置入数目高于对照组(P<0.05),两组患者的年龄、性别、既往史、病变血管部位、心肌损伤指标等差异无统计学意义(P>0.05)。logistic多因素回归分析显示,患者术前血清PCSK9(OR=1.802,95%CI:1.538~2.112,P=0.006)、miR-133a(OR=2.132,95%CI:1.742~2.609,P=0.002)是ACS患者PCI术后发生慢/无复流现象的独立危险因素。PCSK9和miR-133a预测ACS患者PCI术后发生慢/无复流现象的受试者工作特征(ROC)曲线下面积分别为0.808、0.784,最佳预测值分别为76.54μg·L^(-1)、3.98μg·L^(-1),二者联合检测的ROC曲线下面积提升至0.839,高于PCSK9(Z=4.155,P<0.05)、miR-133a(Z=3.754,P<0.05)任一单项指标,灵敏度和特异度分别为80.60%、81.66%(P<0.001)。结论PCSK9和miR-133a对ACS患者PCI术后发生慢/无复流现象具有较高的预测价值,有助于早期识别无复流现象的发生。Objective To investigate the relationship between serum preprotein converting subtilisin kexin type 9(PCSK9),microRNA-133a(miR-133a)and slow/no reflow after direct percutaneous coronary intervention(PCI)in patients with acute coronary syndrome(ACS).Methods A total of 156 patients with ACS who underwent PCI in Fuwai Central China Cardiovascular Hospital from January 2021 to January 2023 were selected as research objects.According to blood flow classification after thrombus therapy(TIMI),the patients were divided into slow/no reflow group(study group,40 cases)and normal blood flow group(control group,116 cases).The differences of preoperative serum PCSK9,miR-133a and other indexes between the two groups were compared,and the relationship between PCSK9,miR-133a and no reflux-free patients after PCI was analyzed.Results Group of patients with serum PCSK9,miR-133a,the number of lesion blood vessel,the number of coronary stenting was higher than the control group(P<0.05).There were no significant differences in age,gender,past medical history,lesion blood vessel parts,such as myocardial injury index between the two groups(P>0.05).Logistic multivariate regression analysis showed that preoperative serum PCSK9(OR=1.802,95%CI:1.538-2.112,P=0.006)and miR-133a(OR=2.132,95%CI:1.742-2.609,P=0.002)were independent risk factors for ACS patients with slow/no reflow after PCI.The area under receiver operating characteristic(ROC)curve of PCSK9 and miR-133a to predict slow/no reflow refluxation after PCI in ACS patients were 0.808 and 0.784,respectively,and the optimal predictive value were 76.54μg·L^(-1) and 3.98μg·L^(-1),respectively.The area under ROC curve of the combined detection of PCSK9 and miR-133a was increased to 0.839,higher than that of PCSK9(Z=4.155,P<0.05),miR-133a(Z=3.754,P<0.05)any single parameter,sensitivity and speciality rate were 80.60%and 81.66%respectively(P<0.001).Conclusion PCSK9 and miR-133a have high predictive value for the occurrence of slow/no reflow phenomenon in ACS patients after PCI,which is he

关 键 词：急性冠脉综合征 慢/无复流 前蛋白转化酶枯草溶菌素9 微小RNA-133a 

分 类 号：R541.4[医药卫生—心血管疾病]