研究STEMI患者RBP4、HbA1c与miR-1-3p检测水平的诊断价值及与病情关系

目的 研究ST段抬高型心肌梗死（ST-segment elevation myocardial infarction，STEMI）患者视黄醇结合蛋白4（retinol-binding protein 4，RBP4）、糖化血红蛋白（glycosylated hemoglobin，HbA1c）与微小RNA（microRNA，miRNA）-1-3p检测水平的诊断价值及与病情关系。 方法 选取河北省保定市第二医院收治的136例STEMI患者为STEMI组，根据SYNTAX评分分为轻度病变组（n=55）、中度病变组（n=43）、重度病变组（n=38）3个亚组，选取同期65例体检健康者为对照组。收集研究对象临床资料，采用酶联免疫吸附测定检测血清RBP4和HbA1c水平，实时荧光定量聚合酶链式反应检测血清miR-1-3p水平。Spearman相关系数分析STEMI患者血清RBP4、HbA1c和miR-1-3p水平与SYNTAX评分的相关性。多因素Logistic回归分析STEMI发生的危险因素。受试者工作特征曲线分析血清RBP4、HbA1c和miR-1-3p水平对STEMI的诊断价值。 结果 与对照组比较，STEMI组吸烟史比例和总胆固醇、三酰甘油、低密度脂蛋白胆固醇（low density lipoprotein cholesterol， LDL-C）、空腹血糖、C反应蛋白（C reactive protein，CRP）、RBP4、HbA1c、miR-1-3p水平升高，高密度脂蛋白胆固醇水平降低（t/Z=2.459~9.608，P均＜0.05）。轻度、中度、重度病变组血清RBP4、HbA1c和miR-1-3p水平依次升高（F=18.202~48.798，P均＜0.001）。STEMI患者血清RBP4、HbA1c和miR-1-3p水平与SYNTAX评分呈正相关（r=0.588~0.647,P均＜0.001）。吸烟史、CRP、LDL-C、RBP4、HbA1c、miR-1-3p可作为STEMI发生的独立危险因素（OR=1.037~1.646，P均＜0.05）。血清RBP4、HbA1c和miR-1-3p联合诊断STEMI的曲线下面积高于各指标单独诊断（Z=3.025~4.213,P均＜0.05）。 结论 STEMI患者血清RBP4、HbA1c和miR-1-3p水平升高，与冠状动脉病变程度正相关，可作为反映STEMI患者病变程度的参考指标。

The diagnostic value of detection of RBP4, HbA1c and miR-1-3p levels in STEMI patients and their relationship with the disease severity

Objective To study the diagnostic value of detection of retinol-binding protein 4(RBP4), glycated hemoglobin(HbA1c) and microRNA(miRNA)-1-3p levels in patients with ST-segment elevation myocardial infarction(STEMI) and their relationship with the disease severity.Methods A total of 136 STEMI patients admitted to the Second Hospital of Baoding City were selected as STEMI group, and divided into three subgroups according to SYNTAX score:mild lesion group(n=55), moderate lesion group(n=43) and severe lesion group(n=38). Anther 65 healthy people who underwent physical examination during the same period were selected as the control group. Clinical data of the study subjects were collected. Serum RBP4 and HbA1c levels were measured by enzyme-linked immunosorbent assay, and serum miR-1-3p levels were measured by quantitative real-time polymerase chain reaction(qRT-PCR). Spearman′s correlation coefficient analysis was used to analyze the correlation of STEMI serum RBP4 and HbA1c with miR-1-3p levels and SYNTAX score. Multivariate logistic regression analysis was used to analyze the risk factors for the development of STEMI. Receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of serum RBP4, HbA1c and miR-1-3p levels for STEMI.Results Compared with the control group, the STEMI group had an increased proportion of smoking history and increased levels of total cholesterol, triglycerides, low-density lipoprotein cholesterol(LDL-C), C-reactive protein(CRP), RBP4, HbA1c, and miR-1-3p and decreased levels of high-density lipoprotein cholesterol(HDL-C)(t/Z=2.459-9.608, all P＜0.05). Serum RBP4, HbA1c and miR-1-3p levels were sequentially increased in the mild, moderate and severe lesion groups(F=18.202-48.798, all P＜0.001). STEMI serum RBP4, HbA1c and miR-1-3p levels were positively correlated with SYNTAX scores(r=0.588-0.647, all P＜0.001). Smoking history, CRP, LDL-C, RBP4, HbA1c and miR-1-3p were independent risk factors for the development of STEMI(OR= 1.037-1.646, all P＜0.05). The area under the ROC curve of the combined detection of serum RBP4, HbA1c and miR-1-3p for the diagnosis of STEMI was higher than that of each indicator alone (Z=3.025-4.213, all P＜0.05).Conclusion Elevated levels of serum RBP4, HbA1c and miR-1-3p in STEMI patients are positively correlated with the degree of coronary artery lesion, which can be used as diagnostic indicators of STEMI.