血清miRNA-1、miRNA-21检测预测PCI术后患者再狭窄的临床价值

摘要

目的 探讨血清中miRNA-1、miRNA-21水平检测对经皮冠状动脉介入术(PCI)后患者半年内扩张部位再狭窄的临床预测价值.方法 选取2014年5月至2016年5月在延安大学咸阳医院接受PCI术的70例冠心病患者(再狭窄组37例,未狭窄组33例),行血管内超声(IVUS)检查,并选择33例体检健康者(对照组),检测各组血清中miRNA-1、miRNA-21水平,采用t检验、Pearson相关性分析及建立受试者工作曲线(ROC曲线)进行比较分析.结果 血清miRNA-1在再狭窄组、未狭窄组和对照组中的表达水平分别为(0.23±0.05)、(0.35±0.09)、(0.91±0.13),血清miRNA-21的水平分别为(0.85±0.15)、(0.36±0.08)、(0.20±0.03).再狭窄组血清miRNA-1水平明显低于对照组,miRNA-21水平则明显高于对照组.而与未狭窄组比较,再狭窄组miRNA-1水平显著下调,miRNA-21水平则显著上调,差异均有显著统计学意义(P<0.01).IVUS结果显示PCI术后再狭窄组外弹力膜内横截面积(EEM)、斑块面积(PLA)和最小管腔面积(MLA)分别为(9.97±2.17)mm2、(11.28±2.75)mm2、(3.78±1.87)mm2;IVUS结果显示PCI术后未再狭窄组EEM、PLA和MLA分别为(13.66±2.28)mm2、(6.13±1.90)mm2、(6.07±2.07)mm2.再狭窄组与未狭窄组比较,PLA显著增高,EEM和MLA显著降低.再狭窄组miRNA-21水平分别与EEM、PLA和MLA有明显的相关性(r=-0.588,P<0.01;r=0.583,P<0.01;r=-0.608,P<0.01);再狭窄组miRNA-1水平分别与EEM、PLA和MLA有相关性(r=0.613,P<0.01;r=-0.605,P<0.01;r=0.593,P<0.01).再狭窄组的血清miRNA-1与miRNA-21水平呈负相关(r=-0.657,P<0.01).ROC曲线分析显示,血清miRNA-21水平的AUC为0.751(95%CI:0.687~0.892,P=0.000);血清miRNA-1水平的AUC为0.722(95%CI:0.679~0.883,P=0.000).根据SPSS统计结果计算出miRNA-21在最佳临界值处诊断PCI术后再狭窄发生及狭窄程度监测的敏感性和特异性为96.9%和95.3%,miRNA-1的敏感性和特异性为90.6%和95.3%.结论 检测PCI术后患者血清中miRNA-1、miRNA-21水平可以预测其扩张部位再狭窄的发生.%Objective To explore the clinical predictive value of the expression of miRNA-1, miRNA-21 in serum for the in-stent restenosis (ISR) of expanded area after percutaneous coronary intervention (PCI) in half a year. Methods From May 2014 to May 2016, 70 patients with coronary heart disease undergoing PCI (37 patients in ISR group and 33 patients in non-ISR group) were selected from Xianyang Hospital of Yan'an University and received intra-vascular ultrasound (IVUS) examination. At the same time, 33 healthy volunteers were enrolled as the control group.The levels of serum miRNA-1, miRNA-21 were measured, compared, and analyzed by t test, Pearson correlation analy-sis and ROC curve. Results The levels of miRNA-1 in ISR group, non-ISR group and control group were (0.23±0.05), (0.35±0.09), (0.91±0.13), respectively, and the miRNA-21 levels were (0.85±0.15), (0.36±0.08), (0.20±0.03), respective-ly. The level of miRNA-1 in ISR group was significantly lower than that in the control group (P<0.01), while miR-NA-21 were significantly higher (P<0.01). The level of miRNA-1 in ISR group was significantly lower in comparing with that in non-ISR group, while miRNA-21 were significantly higher (P<0.01). The results from IVUS examination showed that in the ISR group, external elastic membrane (EEM), plaque area (PLA) and the minimal lumen area (MLA) were, respectively, (9.97±2.17) mm2, (11.28±2.75) mm2, (3.78±1.87) mm2, as compared with (13.66±2.28) mm2, (6.13± 1.90) mm2, (6.07 ± 2.07) mm2 in non-ISR group, with statistically significant differences. The level of miRNA-21 in the ISR group had a significant correlation with EEM, PLA and MLA (r=-0.588, P<0.01; r=0.583, P<0.01; r=-0.608, P<0.01), and miRNA-1 also showed a significant correlation with EEM, PLA and MLA (r=0.613, P<0.01; r=-0.605, P<0.01;r=0.593, P<0.01). There was a negative correlation between the levels of miRNA-1, miRNA-21 in the ISR group (r=-0.657, P<0.01). The results from ROC curve analysis showed that AUC of the levels of serum miRNA-21 was 0.751 (95% CI: 0.687-0.892, P=0.000), and that of serum miRNA-1 was 0.722 (95% CI: 0.679-0.883, P=0.000). SPSS statistics showed that the sensitivity and specificity on the best critical value in diagnosing the occurrence of restenosis after PCI and monitoring stenosis degree were, respectively, 96.9% and 95.3% (miRNA-21), 90.6% and 95.3%(miRNA-1). Conclusion The detection of the levels of miRNA-1, miRNA-21 can predict the occurrence of restenosis of expanded area in postoperative patients with PCI.