【摘要】 目的：探讨血清微小RNA-19a-3p(miR-19a-3p)和微小RNA-194(miR-194)联合颈动脉超声参数对冠心病患者冠状动脉重度狭窄的预测价值。方法：前瞻性选择2022年7月至2024年7月沧州市人民医院收治的冠心病患者为研究对象。本研究主要结局为冠状动脉重度狭窄，定义为Gensini评分>30分。采用实时荧光定量逆转录聚合酶链式反应（qRT-PCR）法检测miR-19a-3p、miR-194表达。采用Pearson法分析miR-19a-3p、miR-194及颈动脉超声参数[颈动脉内膜中层厚度（IMT）、斑块Crouse积分]与冠心病患者Gensini评分的相关性。采用多因素Logistic回归分析血清miR-19a-3p、miR-194及颈动脉超声参数与主要结局的相关性。采用受试者工作特征（ROC）曲线评估miR-19a-3p、miR-194及颈动脉超声参数对冠心病患者重度狭窄的诊断价值。结果：共纳入185例患者进行最终分析，平均年龄（62.4±7.2）岁，男性95例（51.4%），其中重度狭窄83例（44.9%）。Pearson相关分析显示，miR-19a-3p(r=0.612,P<0.001)、IMT(r=0.533,P<0.001)、斑块Crouse积分（r=0.549,P<0.001）与Gensini评分呈正相关，miR-194(r=-0.607,P<0.001)与Gensini评分呈负相关。多因素Logistic回归分析结果显示，miR-19a-3p(OR4.29,95%CI 2.36-7.80)和miR-194(OR 0.42,95%CI 0.27-0.64)与重度狭窄存在显著相关性。ROC曲线结果显示，miR-19a-3p、miR-194水平、IMT和斑块Crouse积分四者联合评估重度冠状动脉狭窄的曲线下面积（AUC）为0.979(95%CI0.962-0.996)，显著高于miR-19a-3p(AUC 0.852,95%CI 0.797-0.906,Z=4.318),miR-194(AUC0.837,95%CI 0.782-0.892,Z=4.828),IMT(AUC0.814,95%CI 0.753-0.875,Z=5.610)和斑块Crouse积分（AUC0.853,95%CI 0.798-0.908,Z=4.284）,P均<0.001。结论：miR-19a-3p水平、IMT、斑块Crouse积分、miR-194水平四者联合能较好预测冠心病患者发生重度冠状动脉狭窄。更多还原

【Abstract】 Objective:To explore the predictive value of serum microRNA-19a-3p(miR-19a-3p),microRNA-194(miR-194)combined with carotid ultrasound parameters for severe coronary artery stenosis in patients with coronary heart disease(CHD).Methods:We included patients with CHD admitted to Cangzhou People’s Hospital between July 2022 and July 2024 in this prospective observational study.The primary outcome was severe coronary artery stenosis,defined as a Gensini score of 30 points or higher.Real-time fluorescence quantitative reverse transcription polymerase chain reaction(qRT-PCR)was used to detect the expressions of miR-19a-3p and miR-194.Pearson method was used to determine the associations of miR-19 a-3 p,miR-194 and carotid ultrasound parameters[carotid intima-media thickness(IMT),plaque Crouse score]with the Gensini score.Multivariate Logistic regression was used to determine the association of primary outcome with miR-19a-3p,miR-194,IMT,and plaque Crouse score.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of miR-19 a-3 p,miR-194 and carotid ultrasound parameters for severe coronary artery stenosis.Results:We included 185 patients in the final analysis.The mean age was(62.4±7.2)years,and 95(51.4%)was male.A total of 83(44.9%)patients had severe coronary artery stenosis.Pearson correlation analysis showed that miR-19a-3p(r=0.612,P<0.001),IMT(r=0.533,P<0.001),plaque Crouse score(r=0.549,P<0.001)were positively associated with the Gensini score,while miR-194(r=-0.607,P<0.001)was inversely associated with the Gensini score.Multivariate Logistic regression analysis showed that miR-19a-3p(OR4.29,95%CI 2.36-7.80)and miR-194(OR0.42,95%CI 0.27-0.64)were significantly associated with the primary outcome.ROC curve showed that a combination of miR-19 a-3 p,miR-194 levels,IMT,and plaque Crouse score had significantly larger area under the curve(AUC0.979,95%CI 0.962-0.996)for diagnosing severe coronary artery stenosis compared to miR-19a-3p(AUC 0.852,95%CI 0.797-0.906),miR-194(AUC0.837,95%CI 0.782-0.892),IMT(AUC0.814,95%CI 0.753-0.875)and plaque Crouse score(AUC0.853,95%CI 0.798-0.908)alone(Z=4.318,4.828,5.610,4.284,P<0.001 all).Conclusion:A combination of miR-19 a-3 p,miR-194 levels,IMT,and plaque Crouse score may predict severe coronary artery stenosis in patients with coronary heart disease.更多还原