李童,米小龙,李学文

• 1:山西医科大学
• 2:山西白求恩医院心内科

摘要(Abstract)：

目的观察血浆微小核糖核酸-21(miRNA-21)、微小核糖核酸-126(miRNA-126)在急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术前后表达水平的变化,探讨二者与心肌缺血再灌注损伤的关系。方法选取2017年6月至2018年12月山西白求恩医院住院治疗的STEMI患者100例,根据冠状动脉造影梗死相关血管心肌梗死溶栓治疗试验血流分级情况分为血管自发再通(SR)组(39例)和非SR组(61例),收集患者临床资料,比较两组患者PCI术前、术后心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、高敏C反应蛋白(hs-CRP)、miRNA-21及miRNA-126的表达水平,分析miRNA-21、miRNA-126与cTnI、CK-MB及hs-CRP的相关性。结果两组患者一般临床资料比较,差异均无统计学意义(均P>0.05)。两组患者PCI术前cTnI、CK-MB及hs-CRP表达水平比较,差异均无统计学意义(均P>0.05);非SR组术后cTnI[(58.43±39.11)ng/ml比(39.66±21.19)ng/ml]、CK-MB[(138.94±69.77)ng/ml比(92.78±37.01)ng/ml]、hs-CRP[(21.33±10.74)mg/L比(16.50±7.64)mg/L]表达水平较SR组更高,差异均有统计学意义(均P<0.05)。两组患者PCI术前miRNA-21和miRNA-126的表达水平比较,差异均无统计学意义(均P>0.05);非SR组患者PCI术后miRNA-21[(1.98±0.46)比(1.68±0.22),P<0.001]、miRNA-126[(2.54±0.56)比(1.63±0.22),P<0.001]表达水平较SR组更高,差异均有统计学意义。Pearson相关性分析显示,miRNA-21表达水平与cTnI(r=0.557,P<0.001)、CK-MB(r=0.625,P<0.001)、hs-CRP(r=0.606,P=0.001)呈正相关,miRNA-126表达水平与cTnI(r=0.543,P=0.004)、CK-MB(r=0.669,P<0.001)、hs-CRP(r=0.558,P=0.002)均呈正相关。结论再灌注损伤时miRNA-21和miRNA-126的表达水平上调,二者与心肌损伤程度呈正相关。

关键词(KeyWords)： 微小核糖核酸;急性ST抬高型心肌梗死;经皮冠状动脉介入治疗;心肌缺血再灌注损伤

Abstract:

Keywords:

基金项目(Foundation): 山西省科学技术厅山西省应用基础研究项目(201701D121148)

作者(Author): 李童,米小龙,李学文

参考文献(References)：

• [1]白瑾，赵威，刘燕娥，等.急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗运动后心率恢复与运动耐量及远期预后相关.中国介入心脏病学杂志，2018,26(2):74-79.
• [2]Fefer P,Hod H,Hammerman H,et al.Relation of clinically def ined spontaneous reperf usion to outcome in ST-elevation myocardial infarction.Am J Cardiol,2009,103(2):149-153.
• [3]Kuwabara Y,Ono K,Horie T,et al.Micro RNA-1 and Micro RNA-133a are useful as early diagnostic biomarkers in patients with acute coronary syndrome.Circulation,2010,122(21):121-124.
• [4]Corsten MF,Dennert R,Jochems S,et al.Circulating micro RNA-208b and micro RNA-499 refl ect myocardial damage in cardiovascular disease.Circ Cardiovasc Genet,2010,3(6):499-506.
• [5]温宁馨，祖凌云，王贵松，等.急性心肌梗死行血栓抽吸患者冠状动脉内微粒与外周血微粒中micro RNA基因芯片的差异性表达分析.中国介入心脏病学杂志，2018,26(1):41-47.
• [6]Cheng Y,Zhu P,Yang J,et al.Ischaemic preconditioning-regulated mi R-21 protects heart against ischaemia/reperfusion injury via antiapoptosis through its target PDCD4.Cardiovasc Res,2010,87(3):431-439.
• [7]Chen F,Du Y,Esposito E,et al.Eff ects of focal cerebral ischemia on exosomal versus serum mi R126.Transl Stroke Res,2015,6(6):478-484.
• [8]中华医学会心血管病学分会，中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南.中华心血管病杂志，2015,43(5):380-393.
• [9]Bainey KR,Fu YL,Wagner GS,et al.Spontaneous reperfusion in ST-elevation myocardial infarction:Comparison of angiographic and electrocardiographic assessments.Am Heart J,2008,156(2):248-255.
• [10]Jennings RB,Sommers HM,Smyth GA,et al.Myocardial necrosis induced by temporary occlusion of a coronary artery in the dog.Arch Pathol,1960,70(1):68-78.
• [11]Wang ZH,Sun XY,Li CL,et al.mi RNA-21 expression in the serum of elderly patients with acute myocardial infarction.Med Sci Monit,2017,23:5728-5734.
• [12]Zhang J,Xing Q,Zhou X,et al.Circulating mi RNA-21 is a promising biomarker for heart failure.Mol Med Rep,2017,16(5):7766-7774.
• [13]Dong S,Cheng Y,Yang J,et al.Micro RNA expression signature and the role of micro RNA-21 in the early phase of acute myocardial infarction.J Biol Chem,2009,284(43):29514-29525.
• [14]Yang Q,Yang K,Li A.Micro RNA-21 protects against ischemiareperfusion and hypoxia-reperfusion-induced cardiocyte apoptosis via the phosphatase and tensin homolog/Akt-dependent mechanism.Mol Med Rep,2014,9(6):2213-2220.
• [15]Tsumaru S,Minakata K,Masumoto H,et al.Angiogenic eff ects of local sustained release of micro RNA-126 in murine hindlimb ischemia.Circulation,2016,134(Suppl 1):A14201.
• [16]Harris TA,Yamakuchi M,Ferlito M,et al.Micro RNA-126regulates endothelial expression of vascular cell adhesion molecule 1.Proc Natl Acad Sci U S A,2008,105(5):1516-1521.
• [17]Zernecke A,Bidzhekov K,Noels H,et al.Delivery of micro RNA-126 by apoptotic bodies induces CXCL12-dependent vascular protection.Sci Signal,2009,2(100):ra81.2019-12-19