| Research background and purpose:Acute myocardial infarction(AMI)refers to an acute disease that can endanger life due to acute obstruction of the coronary artery and necrosis of the heart muscle due to a lack of blood supply,resulting in impaired cardiac function.As a special type of coronary atherosclerotic heart disease(CAHD),it has a high incidence rate and mortality rate worldwide.In China,the overall incidence rate and mortality of AMI are also particularly prominent with the continuous improvement of material life and the increasing aging of the population in recent years.Therefore,it is a key point in clinical work to quickly and accurately classify the risk of patients with AMI and conduct individualized treatment interventions to improve the prognosis.As a member of micro non coding RNA,microRNA-195-5p is stable and easy to detect,and can be detected in various types of cells in the human body.Existing research shows that microRNA-195-5p plays an important role in influencing the expression of inflammatory factors/inflammatory response,and this feature coincides with the role of inflammatory mechanism in coronary atherosclerotic plaque.Moreover,more and more studies have found that microRNA-195-5p can cause cardiac remodeling by influencing inflammatory factors,catecholamine levels,and fibroblast function in the body.In addition,after screening in RNA gene libraries such as Targetscan Human,it was found that microRNA-195-5p can target and regulate Bcl-2.Bcl-2 is an inhibitor of apoptosis gene with the ability to reduce apoptosis,antioxidant stress,and stimulate cell damage.It was also found that Bcl-2 could promote the stability of atherosclerotic plaque and reduce the infarct area in mice with AMI model.However,so far,there has been no study using microRNA-195-5p and Bcl-2 in combination to evaluate the severity and prognosis of AMI.Therefore,this study will be divided into two parts: The first part is to analyze the impact of microRNA-195-5p and Bcl-2 expression levels on the severity of AMI patients;The second part is to study the predictive ability of microRNA-195-5p and Bcl-2 expression levels for short-term prognosis in patients with AMI after reperfusion therapy.Materials and Methods:In the first part,315 patients who were hospitalized and underwent coronary angiography from the Department of Cardiovascular Medicine,the First Affiliated Hospital of Chengdu Medical College from November 2021 to October 2022 will be selected as the study subjects according to the inclusion and exclusion criteria.Then,according to the standard definition,all patients were divided into three groups,including110 patients with AMI,105 patients with chronic coronary syndrome(CCS),and 100 control patients excluded from CAHD diagnosis.Fluorescence quantitative PCR and enzyme linked immunosorbent assay(ELISA)were used to determine the expression levels of microRNA-195-5p and Bcl-2 in patients’ peripheral plasma,and statistical methods were used to analyze the reasons for the differences in the expression levels of microRNA-195-5p and Bcl-2 among the groups.According to the different expression levels of microRNA-195-5p and Bcl-2 in the peripheral plasma of patients with AMI,they were divided into two subgroups: high risk and low risk.The ability of microRNA-195-5p and Bcl-2 to influence the degree of illness of patients with AMI at admission was analyzed.In the second part,according to the inclusion and exclusion criteria,110 patients with AMI who were hospitalized in the Department of Cardiovascular Medicine of the First Affiliated Hospital of Chengdu Medical College from November 2021 to October2022 were selected.Patients with AMI were divided into MACE and non MACE groups based on whether there were major adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI).The differences in the expression of microRNA-195-5p and Bcl-2 between the two groups were analyzed.Then,independent influencing factors for the occurrence of MACE were analyzed based on single factor and multivariate logistic regression analysis,and subject performance characteristic(ROC)curves of microRNA-195-5p,Bcl-2,and their combined predictors were plotted to analyze their predictive value for the occurrence of MACE.Result:Part Ⅰ:1.The relative expression levels of microRNA-195-5p in peripheral plasma of patients with AMI,CCS,and Control were 3.52 ± 1.65 Fold Changes,0.94 ± 0.50 Fold Changes,and 0.18 ± 0.16 Fold Changes,respectively.The expression level of microRNA-195-5p in patients with AMI was significantly higher than that in the other two groups,and there was a statistically significant difference between any two of the three groups(P<0.001).2.The inflammatory factors in the peripheral plasma of patients with AMI,CCS,and Control were measured.The expression of neutrophil to lymphocyte count ratio(NLR)in the three groups was 5.70(3.70,9.66),3.10(2.26,5.09),and 3.30(2.38,4.18),respectively;The expression of C-reactive protein(CRP)in the three groups was 2.85(1.00,6.93)mg/L,1.00(1.00,1.20)mg/L,and 1.00(1.00,1.00)mg/L.After analysis,it was found that the expression of inflammatory factors in patients with AMI was significantly higher than that in the other two groups,with a statistically significant difference(P<0.05).3.Spearman correlation analysis was performed on microRNA-195-5p,NLR,and CRP in peripheral plasma of patients with AMI.Analysis showed that microRNA-195-5p had a positive correlation with NLR,with a correlation coefficient of R=0.285,P=0.003;microRNA-195-5p was positively correlated with CRP,with a correlation coefficient of R=0.246 and P=0.009.4.The expression levels of Bcl-2 in peripheral plasma of patients with AMI,CCS,and Control were 109.54 ± 26.09 ng/m L,132.58 ± 14.85 ng/m L,and 139.46± 8.59 ng/m L,respectively.The expression of Bcl-2 in patients with AMI decreased significantly compared to the other two groups,and there was a statistically significant difference between any two of the three groups(P<0.05).5.Pearson correlation analysis of peripheral plasma microRNA-195-5p and Bcl-2 in any group of patients showed a significant negative correlation between microRNA-195-5p and Bcl-2(P<0.001).6.In the AMI group,the population with a higher expression of microRNA-195-5p in peripheral plasma than the median(3.52 Fold Changes)and a lower or equal expression of Bcl-2(109.05 ng/m L)was defined as a high-risk group,while the rest of the population was defined as a low-risk group.The analysis showed that the high-risk group was significantly higher than the low-risk group in terms of the proportion of patients with a Killip grade greater than Grade II(%)(26.0 vs 8.3),the GRACE score(score)(179.02 ±33.11 vs.157.57 ± 32.13),the GRACE score(high risk)(%)(90.0 vs.60.0),the proportion of high-risk events(before reperfusion treatment)before treatment(%)(22.0 vs.8.3),and the Gensini score(score)(139.46 ± 56.71 vs.119.38 ± 45.70),The difference was statistically significant(P<0.05).Part Ⅱ:1.Patients with AMI were divided into MACE group and non MACE group based on whether they experienced MACE during hospitalization after PCI treatment.The analysis showed that the relative expression level of microRNA-195-5p(Fold Change)in the peripheral plasma of patients in the MACE group was significantly higher than that in the non MACE group(4.83 ± 1.18 vs.2.93 ± 1.49,P<0.001);The expression of Bcl-2(ng/m L)was significantly lower in the non MACE group(87.20 ± 17.28 vs.118.83 ± 23.34,P<0.001);The LVEF(%)of patients in the MACE group was significantly lower than that in the non MACE group(53 ± 4 vs.56 ± 4,P=0.009),with statistically significant differences.2.Whether there is MACE in the hospital after PCI treatment for AMI patients was the research object.Multiple influencing factors including microRNA-195-5p and Bcl-2were screened through single factor and multivariate logistic regression.However,after collinearity diagnosis and analysis,microRNA-195-5p and Bcl-2 are found to be collinearity,so they cannot be considered as independent influencing factors for the occurrence of MACE in patients with AMI after PCI treatment.3.microRNA195-5p(AUC: 0.849,95% CI: 0.772～0.927,P<0.001)was obtained by analysis.Taking 3.77 Fold Changes as the optimal threshold for microRNA195-5p,the sensitivity was 88.2%,and the specificity was 73.7%;Bcl-2(AUC: 0.833,95% CI:0.758～0.909,P<0.001),with 98.86 ng/m L as the optimal threshold for Bcl-2,the sensitivity is 79.4%,and the specificity is 80.3%;The combined predictive factor(AUC:0.850,95% CI: 0.773～0.928,P<0.001),with 0.33 as the optimal threshold,had a sensitivity of 91.2% and a specificity of 77.6%.Therefore,microRNA-195-5p,Bcl-2,and combined predictors have certain predictive value for the occurrence of MACE in patients with AMI after PCI treatment.Conclusion:1.There was a significant negative correlation between the expression of microRNA-195-5p and Bcl-2 in peripheral plasma.AMI patients with high expression of microRNA-195-5p and low expression of Bcl-2 are more severely affected upon admission.2.AMI patients with high expression of microRNA-195-5p and low expression of Bcl-2 are more likely to have MACE in the hospital after PCI treatment. |
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