CAJ | 학술논문

目的探讨他汀类药物对冠心病患者循环微小RNA-92a( miR-92a)的调节作用,评价miR-92a作为新血管内皮损伤治疗靶点的临床应用价值.方法采用病例对照研究方法,分析236例冠心病患者的血脂异常率、他汀类药物治疗率以及治疗后低密度脂蛋白胆固醇(LDL-C)达标率;多因素方差分析他汀类药物治疗对合并2型糖尿病(DM)冠心病患者LDL-C及循环miR-92a表达的影响,比较各组治疗后急性冠脉综合征(ACS)的发生率.结果冠心病非他汀类药物治疗患者LDL-C未达标率高达95.7％(112/117),应获得而未得到他汀类药物治疗者占47.5％(112/236);他汀类药物治疗者LDL-C达标率为27.7％( 33/119).冠心病他汀类药物治疗组LDL-C( mmol/L)显著低于非治疗组(2.457±0.802比3.218±1.130,Z=-9.760,P=0.001),ACS发生率也显著低于非治疗组(33.6％比71.8％,x2=34.491,P=0.001).在他汀类药物治疗组中,LDL-C达标者与未达标者ACS发生率无明显差异(33.3％比33.7％,x2=0.002,P=0.968).稳定型心绞痛(SAP)合并DM患者循环miR-92a表达显著高于未合并DM者(0.492比-0.121,Z=-3.038,P=0.002);他汀类药物治疗的SAP合并DM者循环miR-92a表达低于非治疗者(0.419比0.687,Z=1.289,P=0.072);他汀类药物治疗的SAP未合并DM患者与非治疗者循环miR-92a表达差异无统计学意义(-0.032比-0.198,Z=-0.614,P=0.539).多因素方差分析显示:他汀类药物治疗是影响冠心病患者LDL-C水平的主要因素(F=22.863,P=0.001),合并DM是影响SAP患者循环miR-92a表达的主要因素(F=9.641,P=0.003).结论他汀类药物通过调控循环miR-92a表达,对减轻冠心病患者的血管内皮损伤可能具有临床意义.
목적 탐토타정류약물대관심병환자순배미소RNA-92a( miR-92a)적조절작용,평개miR-92a작위신혈관내피손상치료파점적림상응용개치.방법 채용병례대조연구방법,분석236례관심병환자적혈지이상솔、타정류약물치료솔이급치료후저밀도지단백담고순(LDL-C)체표솔;다인소방차분석타정류약물치료대합병2형당뇨병(DM)관심병환자LDL-C급순배miR-92a표체적영향,비교각조치료후급성관맥종합정(ACS)적발생솔.결과 관심병비타정류약물치료환자LDL-C미체표솔고체95.7％(112/117),응획득이미득도타정류약물치료자점47.5％(112/236);타정류약물치료자LDL-C체표솔위27.7％( 33/119).관심병타정류약물치료조LDL-C( mmol/L)현저저우비치료조(2.457±0.802비3.218±1.130,Z=-9.760,P=0.001),ACS발생솔야현저저우비치료조(33.6％비71.8％,x2=34.491,P=0.001).재타정류약물치료조중,LDL-C체표자여미체표자ACS발생솔무명현차이(33.3％비33.7％,x2=0.002,P=0.968).은정형심교통(SAP)합병DM환자순배miR-92a표체현저고우미합병DM자(0.492비-0.121,Z=-3.038,P=0.002);타정류약물치료적SAP합병DM자순배miR-92a표체저우비치료자(0.419비0.687,Z=1.289,P=0.072);타정류약물치료적SAP미합병DM환자여비치료자순배miR-92a표체차이무통계학의의(-0.032비-0.198,Z=-0.614,P=0.539).다인소방차분석현시:타정류약물치료시영향관심병환자LDL-C수평적주요인소(F=22.863,P=0.001),합병DM시영향SAP환자순배miR-92a표체적주요인소(F=9.641,P=0.003).결론 타정류약물통과조공순배miR-92a표체,대감경관심병환자적혈관내피손상가능구유림상의의.
Objective To inveshgate the modulatory function ot statin therapy on circulatmg microRNA-92a (miR-92a) in patients with coronary heart disease (CHD),and to evaluate the possibility of miR-92a as a new target of treatment for endothelial dysfunction.Methods A case control study was conducted.Prevalence of abnormal blood fat content,statin treatment rate,and attainment rateoflowdensitylipoprotein-cholesterol (LDL-C) lowered toexpected level in 236 patients with CHD were analyzed.Relationship between statin therapy in patients with type 2 diabetes mellitus (DM),and level of LDL-C and circulating miR-92a expression was analyzed by multivariate general linear factorial analysis.The incidence of acute coronary syndrome (ACS) was compared in patients with CHD receiving statin therapy in all groups.Results Prevalence of abnormal LDL-C was 95.7％ ( 112/117 ) in CHD patients of non-statin therapy group,and 47.5％ (112/236) of patients with CHD who should receive statin therapy but did not.Attainment rate of lowering of LDL-C to expected level in statin therapy group was 27.7％ (33/119).LDL-C level (mmol/L) was significantly lower in statin therapy group than that in non-statin therapy group (2.457 ± 0.802 vs.3.218 ± 1.130,Z=-9.760,P=0.001 ),and incidence of ACS was significantly lower in statin therapy group than that in non-statin therapy group (33.6％ vs.71.8％,x2=34.491,P=0.001 ).Tbere was no significant difference in incidence of ACS between patients with or without attaining the expected low value of LDL-C in statin therapy group ( 33.3％ vs.33.7％,x2 =0.002,P=0.968 ).Circulating miR-92a expression was significantly higher in patients with stable angina pectioris (SAP) complicated with DM than those without DM (0.492 vs.-0.121,Z=-3.038,P=0.002).It was found that statin therapy could down regulate miR-92a expression in patients with SAP complicated with DM as compared with that with non-statin therapy (0.419 vs.0.687,Z=1.289,P=0.072).There was no significant differeuce in circulating miR-92a expression between statin therapy and non-statin therapy in patients with SAP without co-existing DM (-0.032 vs.-0.198,Z=-0.614,P=0.539 ).Multivariate general linear factorial analysis showed that statin therapy was the major influential factor on LDL-C level in patients with CHD (F=22.863,P=0.001 ),and complicating DM was the major influential factor on circulating miR-92a expression in patients with SAP (F =9.641,P=0.003).Conclusion Regulation ofcirculating miR-92a expression may be considered as a new clinical target for statin treating endothelial dysfunction in patients with CHD.