| Objective To investigate the changes of serum mi RNA-499 and mi RNA-208 b in patients with AMI(Acute myocardial infarction,AMI)and the significances in clinical diagnosis,to discuss their correlation to coronary artery lesion severity,and to evaluate the predictive value in MACE(Major Adverse Cardiovascular Events,MACE)occurrence among AMI patients undergone PCI(Percutaneous coronary intervention,PCI).Method A total of 208 patients admitted to department cardiology of Liaocheng hospital(2015.04-2016.04)were recruited in this study.According to clinical symptom and imageological results,patients were divided into normal group(n=48),UA(Unstable Angina Pectoris)group(n=92),USTEMI(Non-ST Segment Elevation Myocardial Infarction)group(n=45),and STEMI(ST Segment Elevation Myocardial Infarction)group(n=23).Peripheral venous blood was obtained for serum separation and total mi RNA extraction,and the serum levels of mi RNA(micro RNA,mi RNA)-208 b and mi RNA-499 were measured by q RT-PCR.CK-MB(Creatine Kinase Myocardial Band,CKMB),c-Tn I(Cardiac Troponin I,c-Tn I),LDL-C(Low density lipoprotein cholesterol,LDL-C)and HDL-C(High density lipoprotein cholesterol,HDL-C)were measured by chemiluminiscence method.The severity of coronary stenosis was assessed by the SYNTAX scoring system and analyzed its association with mi RNA.All the patients had been followdeup 6-9 months among PCI patients and the occurrence of MACE(includes death,repeated revascularization,angina and non-fatal myocardial infarction)was recorded.Data was enterred to Excel 2010 then statistical analysis(α=0.05 of both sides)was accomplished by SPSS 20.0.Measurement data was displayed by sx ±,comparison among multiple groups was made by variance analysis,pairwise comparison was conducted by LSD-t method(Dunnett-t for heterogeneity of variance);COX regression multivariate analysis was applied to analyze the influence factors for the MACE occurrence during follow-up visits after PCI.Result 1.Comparison of baseline data between different groups Compared with the control group,there was no significant difference between the other three groups.2.Comparison of serum mi RNA-499 level: The serum levels of mi RNA-499 in UA group(4.26±1.41),NSTEMI group(5.20±1.98)and STEMI group(5.28±1.89)were significantly higher than normal group(2.77± 1.71)(all P<0.05).The serum levels of mi RNA-499 in NSTEMI group(5.20±1.98)and STEMI group(5.28±1.89)were significantly higher than UA group(4.26±1.41)(all P<0.05);No statistical significance in serum mi RNA-499 level was observed between STEMI group(5.28±1.89)and NSTEMI group(5.20±1.98)(P>0.05).3.Comparison of serum mi RNA-208 b level: The serum levels of mi RNA-208 b in UA group(3.27±0.97),NSTEMI group(4.03±1.18)and STEMI group(5.72±2.26)were significantly higher than normal group(1.94± 1.30)(all P<0.05).The serum levels of mi RNA-208 b in NSTEMI group(4.03±1.18)and STEMI group(5.72±2.26)were significantly higher than UA group(3.27±0.97)(all P<0.05).Statistical significance in serum mi RNA-208 b level was observed between STEMI group(5.72±2.26)and NSTEMI group(4.03±1.18)(P<0.05).4.The effectiveness of two kinds of mi RNA and common myocardial enzyme indicators The AUC(Area Under Curve)of serum mi RNA-499 ROC(Receiver Operating Characteristic Curve)was 0.73 with 66.17% sensitivity and 82.35% specificity.The AUC of serum mi RNA-208 b ROC was 0.80 with 70.59% sensitivity and 88.23% specificity.The AUC of serum CK-MB ROC was 0.799 with 69.12% sensitivity and 76.43% specificity.The AUC of serum C-Tn I ROC was 0.991 with 91.18% sensitivity and 100% specificity.5.The correlation between serum mi RNA levels and SYNTAX score of coronary artery lesion Based on SYNTAX scoring criteria to evaluate the coronary angiography and coronary artery CTA,included cases were divided into low-score group(0<SYNTAX score≤22),medium-score group(22<SYNTAX score≤33)and high-score group(33< SYNTAX score).5.1 relationship between serum mi RNA-499 level and coronary artery lesion The serum mi RNA-499 level in high-score group(5.13±1.86)was significantly higher than medium-score(4.18±1.44)and low-score groups(3.01±1.77)(all p<0.05);No statistical significance in serum mi RNA-499 level was observed between mediumscore group(4.18±1.44)and low-score group(3.01±1.77)(p>0.05).5.2 relationship between serum mi RNA-208 level and coronary artery lesion The serum mi RNA-208 b level in high-score group(4.43±1.72)was significantly higher than medium-score(3.28±1.02)and low-score groups(2.08±1.31)(all p<0.05);The serum mi RNA-208 b level in medium-score group(3.28±1.02)was significantly higher than that of low-score group(2.08±1.31)(all p>0.05).6.The relationship between mi RNA and MACE 6.1 MACE of PCI: Based on the follow-up visits among 128 AMI patients after PCI,the MACE during 6-9 months was recorded.There were 11 cases lost to follow-up resulting in a rate of 8.59%.A total of 26 MACE cases(22.80%)reported,including 15 cases of angina(11.71%),1 case of death(0.78%),2 cases of non-fatal myocardial infarction(1.56%)and 7 cases of repeated revascularization(4.44%).There were 60 PCI cases in UA group,with 6 cases lost and a rate of 10%.A total of 4 MACE cases were reported(6.67%),which were all angina cases(6.67%).There were 45 PCI cases in NSTEMI group,with 3 cases lost and a rate of 6.67%.A total of 15 MACE cases were reported(3.33%),including 8 cases of angina(17.78%),2 cases of non-fatal myocardial infarction(4.44%)and 2 cases of repeated revascularization(4.44%).There were 23 PCI cases in STEMI group,with 2 cases lost and a rate of 8.70%.A total of 11 MACE cases were reported(3.33%),including 3 cases of angina(13.04%),5 cases of repeated revascularization(21.74%)and 1 case of death(4.3%).6.2By COX regression multivariate analysis,the elevation of serum mi RNA-208 b level might be one of the predictive factors for PCI postoperative MACE occurrence.Conclusion:1.Comparing to CKMB and mi RNA-499,serum mi RNA-208 b had higher sensitivity and specificity in AMI diagnosis,which was a potential candidate as an AMI diagnostic indicator;2.The serum level of mi RNA-208 b was able to act as a predictive indicator of MACE occurrence among AMI patients after PCI. |
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