Abstract: Objective Predictive value of plasma miR-93-5p was investigated for restenosis after cerebrovascular stent implantation (ISR),as well as its relationship with vasoactive substances and inflammatory cytokines.Methods A total of 132 patients with cerebral infarction who underwent cerebral vascular stent implantation in our hospital and had restenosis during 9-month ultrasonic follow-up were recruited as ISR group,and 124 patients without restenosis evidence were selected as non ISR group according to the ratio of 1:1.The plasma miR-93-5p was detected by real-time fluorescent quantitative PCR.Serum nitric oxide (NO),tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) levels were measured by enzyme-linked immunosorbent assay.Results Plasma miR-93-5p level in ISR group was significantly higher than that in non-ISR group (P< 0.001).Serum NO level in ISR group was significantly lower than that in non-ISR group,and serum TNF-α and IL-6 levels were significantly higher than those in non-ISR group (P＜0.001).The sensitivity,specificity,area under the curve and cut-off of plasma miR-93-5p in diagnosing restenosis after cerebrovascular stent implantation were 70.5%,94.4%,0.873 and 1.254,respectively.Spearman rank correlation coefficient analysis showed that plasmamiR-93-5p level was negatively correlated with NO (r=-0.290,P<0.001),positively correlated with IL-6 (r=0.182,P=0.037) and TNF-α (r=0.207,P=0.017) (P<0.001).Multivariate COX model analysis showed that the increase of plasma miR-93-5p level,stent length > 15mm,serum IL-6 and TNF-α levels were independent risk factors affecting the risk of ISR (P<0.05).Conclusion The plasma miR-93-5p is an independent risk factor for restenosis after cerebrovascular stent implantation,which would be the potential target for the early prevention.

Key words: Cerebrovascular stent, Cerebral infarction, In-stent restenosis, miR-93-5p, Iinflammation

摘要： 目的 研究了血浆miR-93-5p对脑血管支架植入后再狭窄(ISR)的预测价值,以及其与血管活性物质和炎症细胞因子的关系。方法 2017年3月至2021年1月,共招募132例在我院接受脑血管支架植入术且在术后9个月超声随访中发生再狭窄的脑梗死患者作为ISR组,按1:1比例选取无再狭窄证据的患者124例作为非ISR组。采用实时荧光定量PCR法检测血浆miR-93-5p水平。酶联免疫吸附法检测血清一氧化氮(NO)、肿瘤坏死因子-α(TNF-α)、白细胞介素6(IL-6)水平。结果 ISR组血浆miR-93-5p水平为明显高于非ISR组(P＜0.001)。ISR组血清NO水平明显低于非ISR组,同时血清TNF-α和IL-6水平显著高于非ISR组(P＜0.001)。血浆miR-93-5P水平诊断脑血管支架植入后再狭窄的敏感性、特异性、曲线下面积和cut-off分别为70.5%、94.4%、0.873和1.254。利用Spearman秩相关系数分析,ISR组患者脑血管支架植入后,血浆miR-93-5p水平与NO呈负相关(r=-0.290,P＜0.001),与IL-6(r=0.182,P=0.037)和TNF-α(r=0.207,P=0.017)呈正相关(P＜0.001)。多因素COX模型分析结果显示,血浆miR-93-5p水平升高、支架长度＞15mm、血清IL-6、TNF-α水平升高为影响ISR发病风险的独立高危因素(P＜0.05)。结论 血浆miR-93-5p水平升高为脑血管支架植入后再狭窄的独立高危因素,可作为早期预防的重要靶点。

关键词: 脑血管支架, 脑梗死, 支架内再狭窄, miR-93-5p, 炎症