老年急性冠脉综合征患者PCI术前血清miR-34a、miR-182水平与术后对比剂肾病发生的相关性

doi:10.11958/20231183

天津医药 ›› 2024, Vol. 52 ›› Issue (4): 422-426.doi: 10.11958/20231183

老年急性冠脉综合征患者PCI术前血清miR-34a、miR-182水平与术后对比剂肾病发生的相关性

薛文平¹(), 秦巍¹, 刘婷婷², 张爱文¹, 史菲¹^,^△()

1 承德医学院附属医院本部心脏内科（邮编067020）
2 承德医学院附属医院本部门诊部（邮编067020）

收稿日期:2023-08-21 修回日期:2023-11-06 出版日期:2024-04-15 发布日期:2024-04-19
通讯作者: ^△E-mail：shifeisf@aliyun.com
作者简介:薛文平（1987），女，主治医师，主要从事心脏疾病诊治方面研究。E-mail：xuewenping537@163.com
基金资助:
河北省医学科学研究课题计划项目(20220547);承德市科学技术研究与发展计划项目(201904A043)

Correlation between serum miR-34a and miR-182 levels before PCI and postoperative contrast-induced nephropathy occurrence in elderly patients with acute coronary syndrome

XUE Wenping¹(), QIN Wei¹, LIU Tingting², ZHANG Aiwen¹, SHI Fei¹^,^△()

1 Department of Cardiology, Affiliated Hospital of Chengde Medical College, Chengde 067020, China
2 Department of Outpatient, Affiliated Hospital of Chengde Medical College, Chengde 067020, China

Received:2023-08-21 Revised:2023-11-06 Published:2024-04-15 Online:2024-04-19
Contact: ^△E-mail：shifeisf@aliyun.com

薛文平, 秦巍, 刘婷婷, 张爱文, 史菲. 老年急性冠脉综合征患者PCI术前血清miR-34a、miR-182水平与术后对比剂肾病发生的相关性[J]. 天津医药, 2024, 52(4): 422-426.

XUE Wenping, QIN Wei, LIU Tingting, ZHANG Aiwen, SHI Fei. Correlation between serum miR-34a and miR-182 levels before PCI and postoperative contrast-induced nephropathy occurrence in elderly patients with acute coronary syndrome[J]. Tianjin Medical Journal, 2024, 52(4): 422-426.

摘要/Abstract

摘要：

目的探究老年急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）术前血清微小RNA（miR）-34a、miR-182水平与术后对比剂肾病（CIN）发生的关系。方法纳入行PCI治疗的146例老年ACS患者。收集ACS患者临床资料；全自动生化分析仪检测术前血脂、肾功能指标；实时荧光定量PCR法测定血清miR-34a、miR-182水平。根据患者PCI术后是否发生CIN分为CIN组（20例）和非CIN组（126例）。比较CIN组和非CIN组临床资料、术前血脂、肾功能指标、血清miR-34a、miR-182、术后血清肌酐（Scr）、肾小球滤过率（eGFR）水平；分析老年ACS患者术前血清miR-34a、miR-182、术后Scr、eGFR的相关性及影响老年ACS患者PCI术后发生CIN的因素，受试者工作特征（ROC）曲线评估术前血清miR-34a、miR-182水平对老年ACS患者PCI术后发生CIN的预测价值。结果 CIN组术前血清miR-34a和miR-182水平、术后Scr水平均高于非CIN组，术后eGFR水平低于非CIN组（P<0.05）；ACS患者术前血清miR-34a、miR-182与术后Scr呈正相关，与术后eGFR呈负相关（P<0.05）；术前血清miR-34a与miR-182呈正相关（P<0.05）；术前血清miR-34a、miR-182水平升高是影响老年ACS患者PCI术后发生CIN的独立危险因素（P<0.05）；术前血清miR-34a、miR-182及两者联合预测老年ACS患者PCI术后发生CIN的曲线下面积（AUC）分别为0.881、0.888、0.964，两者联合预测的AUC高于各自单独预测（P<0.05）。结论术前血清miR-34a、miR-182水平升高是老年ACS患者PCI术后发生CIN的危险因素，两者联合可有效预测CIN的发生。

关键词: 急性冠状动脉综合征, 经皮冠状动脉介入治疗, 微小RNA-34a, 微小RNA-182, 对比剂肾病

Abstract:

Objective To investigate the relationship between serum microRNA (miR)-34a and miR-182 levels before percutaneous coronary intervention (PCI) and postoperative contrast-induced nephropathy (CIN) occurrence in elderly patients with acute coronary syndrome (ACS). Methods A total of 146 elderly patients with ACS who underwent PCI were included. Clinical data of ACS patients were collected. The indexes of preoperative blood lipid and renal function were detected by automatic biochemical analyzer. Serum levels of miR-34a and miR-182 were determined by real time fluorescence quantitative PCR. Patients were divided into the CIN group (20 cases) and non-CIN group (126 cases) according to whether CIN occurred after PCI. Clinical data, preoperative blood lipids, renal function indexes, serum miR-34a, miR-182, postoperative serum creatinine (Scr) and glomerular filtration rate (eGFR) were compared between the CIN group and the non-CIN group. The correlation of preoperative serum miR-34a, miR-182, postoperative Scr, and eGFR in elderly patients with ACS were analyzed, and factors affecting the occurrence of CIN in elderly patients with ACS after PCI were also analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of preoperative serum miR-34a and miR-182 levels for occurrence of CIN in elderly patients with ACS after PCI. Results Preoperative serum miR-34a and miR-182 levels and postoperative Scr levels were higher in the CIN group than those in the non-CIN group, while postoperative eGFR level was lower than those in the non-CIN group (P<0.05). Preoperative serum miR-34a and miR-182 were positively correlated with postoperative Scr, and negatively correlated with postoperative eGFR in elderly patients with ACS (P<0.05). Preoperative serum miR-34a was positively correlated with miR-182 (P<0.05). The increase of serum miR-34a and miR-182 levels before surgery were an independent risk factor for occurrence of CIN in elderly patients with ACS after PCI (P<0.05). The area under curve (AUC) of preoperative serum miR-34a, miR-182 and their combination in predicting postoperative occurrence of CIN in elderly ACS patients after PCI were 0.881, 0.888, and 0.964, respectively. The AUC predicted by the two combined was higher than that predicted by each separately (P<0.05). Conclusion The increased serum levels of miR-34a and miR-182 before surgery are risk factors for occurrence of CIN in elderly patients with ACS after PCI, and the combination of the two can effectively predict the occurrence of CIN.

Key words: acute coronary syndrome, percutaneous coronary intervention, microRNA-34a, microRNA-182, contrast-induced nephropathy

中图分类号:

R541.4，R692.9

图/表 7

参考文献 22

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基因名称	引物序列（5′→3′）	产物大小/bp
miR-34a	上游：CGGTATCATTTGGCAGTGTCT	46
miR-34a	下游：GTGCAGGGTCCGAGGT	46
miR-182	上游：TTTGGCAATGGTAGAACTCACACT	90
	下游：GCTTTGGCAATGGTAGAACTCACACT	90
U6	上游：CGCTTCGGCAGCACATATAC	139
	下游：AAAATATGGAACGCTTCACGA	139

基因名称	引物序列（5′→3′）	产物大小/bp
miR-34a	上游：CGGTATCATTTGGCAGTGTCT	46
miR-34a	下游：GTGCAGGGTCCGAGGT	46
miR-182	上游：TTTGGCAATGGTAGAACTCACACT	90
	下游：GCTTTGGCAATGGTAGAACTCACACT	90
U6	上游：CGCTTCGGCAGCACATATAC	139
	下游：AAAATATGGAACGCTTCACGA	139

组别	n	性别（男/女）	年龄/岁	BMI/（kg/m²）	高血压（是/否）	糖尿病（是/否）	高脂血症（是/否）	对比剂用量/mL	TC/（mmol/L）
非CIN组	126	68/58	70.10±7.53	23.57±2.48	50/76	55/71	51/75	155.29±26.84	4.43±0.61
CIN组	20	12/8	70.17±7.58	24.07±2.26	12/8	7/13	6/14	158.47±30.33	4.37±0.59
χ²或t		0.254	0.039	0.847	2.916	0.529	0.796	0.483	0.410
组别	TG/（mmol/L）			HDL-C/（mmol/L）	LDL-C/（mmol/L）		Scr/（μmol/L）	BUN/（mmol/L）	UA/（μmol/L）
非CIN组	1.45±0.36			0.91±0.21	3.11±0.56		64.01±8.04	5.23±1.05	257.34±43.59
CIN组	1.49±0.34			0.89±0.18	3.19±0.61		63.59±7.62	5.17±1.02	262.54±46.07
χ²或t	0.465			0.403	0.586		0.219	0.238	0.492

组别	n	性别（男/女）	年龄/岁	BMI/（kg/m²）	高血压（是/否）	糖尿病（是/否）	高脂血症（是/否）	对比剂用量/mL	TC/（mmol/L）
非CIN组	126	68/58	70.10±7.53	23.57±2.48	50/76	55/71	51/75	155.29±26.84	4.43±0.61
CIN组	20	12/8	70.17±7.58	24.07±2.26	12/8	7/13	6/14	158.47±30.33	4.37±0.59
χ²或t		0.254	0.039	0.847	2.916	0.529	0.796	0.483	0.410
组别	TG/（mmol/L）			HDL-C/（mmol/L）	LDL-C/（mmol/L）		Scr/（μmol/L）	BUN/（mmol/L）	UA/（μmol/L）
非CIN组	1.45±0.36			0.91±0.21	3.11±0.56		64.01±8.04	5.23±1.05	257.34±43.59
CIN组	1.49±0.34			0.89±0.18	3.19±0.61		63.59±7.62	5.17±1.02	262.54±46.07
χ²或t	0.465			0.403	0.586		0.219	0.238	0.492

组别	n	miR-34a	miR-182
非CIN组	126	1.01±0.12	1.02±0.09
CIN组	20	1.47±0.33	2.35±0.52
t		11.659^＊＊	26.737^＊＊

老年急性冠脉综合征患者PCI术前血清miR-34a、miR-182水平与术后对比剂肾病发生的相关性

Correlation between serum miR-34a and miR-182 levels before PCI and postoperative contrast-induced nephropathy occurrence in elderly patients with acute coronary syndrome

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组别	n	Scr/（μmol/L）	eGFR/[mL/（min· 1.73 m²）]
非CIN组	126	64.12±9.27	105.84±12.22
CIN组	20	98.74±13.23	81.83±10.27
t		14.552^＊＊	8.326^＊＊

自变量	B	SE	Wald χ²	P	OR	OR 95%CI
miR-34a	0.324	0.114	8.054	0.005	1.382	1.105~1.728
miR-182	0.428	0.163	6.891	0.009	1.534	1.114~2.112
常数项	-17.323	7.609	5.183	0.026	<0.001

变量	截断值	AUC	AUC 95%CI	敏感度/%	特异度/%	约登指数
miR-34a	1.19	0.881	0.806~0.956	81.52	76.16	0.577
miR-182	1.81	0.888	0.821~0.956	74.51	80.48	0.550
两者联合		0.964	0.933~0.995	97.73	73.29	0.710

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