[1]董 佳,寇拉娣.急性STEMI患者PCI术后外周血循环细胞外囊泡MORN4，CD40L表达水平与SYNTAX II评分和预后的关系研究[J].现代检验医学杂志,2025,40(04):29-34.[doi:10.3969/j.issn.1671-7414.2025.04.006]
　DONG Jia,KOU Ladi.Relationship between Peripheral Blood Circulating Extracellular Vesicles MORN4 and CD40L Expression Levels and SYNTAX-II Score and Prognosis in Acute STEMI Patients after PCI[J].Journal of Modern Laboratory Medicine,2025,40(04):29-34.[doi:10.3969/j.issn.1671-7414.2025.04.006]
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急性STEMI患者PCI术后外周血循环细胞外囊泡MORN4，CD40L表达水平与SYNTAX II评分和预后的关系研究()

《现代检验医学杂志》[ISSN:/CN:]

卷:
第40卷
期数:
2025年04期
页码:
29-34
栏目:
论著
出版日期:
2025-07-15

文章信息/Info

Title:
Relationship between Peripheral Blood Circulating Extracellular Vesicles MORN4 and CD40L Expression Levels and SYNTAX-II Score and Prognosis in Acute STEMI Patients after PCI
文章编号:
1671-7414（2025）04-029-06
作者:
董 佳，寇拉娣
（陕西中医药大学附属医院心血管二科，陕西咸阳 712000）
Author(s):
DONG Jia，KOU Ladi
(Department of NO 2. Cardiology，Affiliated Hospital of Shaanxi University of Chinese Medicine，Shaanxi Xianyang 712000，China)
关键词:
ST 段抬高型心肌梗死; 细胞外囊泡; 膜占位和识别联结小体结构域蛋白4; 白细胞分化抗原40 配体; SYNTAX-II 评分; 主要心血管不良事件
分类号:
R542.22；R392.11
DOI:
10.3969/j.issn.1671-7414.2025.04.006
文献标志码:
A
摘要:
目的 研究急性ST 段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）术后外周血循环细胞外囊泡中膜占位和识别联结小体结构域蛋白4（MORN4）、白细胞分化抗原40 配体（CD40L）表达水平与SYNTAX-II评分和预后的关系。方法 回顾性选择2020 年6 月～ 2023 年5 月于陕西中医药大学附属医院行PCI 的急性STEMI 患者268 例；根据随访一年期间是否发生主要不良心血管事件（MACE）将患者分为MACE 组及非MACE 组。实时荧光定量PCR（RT-qPCR）检测两组外周血循环细胞外囊泡中MORN4，CD40L 的mRNA 表达水平。对比两组临床资料、实验室指标及MORN4，CD40L 表达差异。Pearson 相关性分析MORN4，CD40L 表达水平与SYNTAX- Ⅱ评分的相关性。多因素Logistics 回归模型分析PCI 术后发生MACE 的危险因素。绘制受试者工作特征（ROC）曲线，计算曲线下面积（AUC），分析MORN4，CD40L 表达水平预测MACE 发生的价值。结果 术后一年内，75 例患者发生MACE。临床资料比较，MACE 组病变血管支数、支架数目、SYNTAX- Ⅱ评分高于非MACE 组，差异具有统计学意义（χ2/t=4.451，2.625，11.553，均P<0.05）。MACE 组MORN4 mRNA（2.16±0.54）和CD40L mRNA（1.87±0.25）表达水平高于非MACE 组（1.24±0.31，1.13±0.19），差异具有统计学意义（t=17.429，26.092，均P<0.05）。Pearson 相关性分析，MORN4，CD40L 表达分别与SYNTAX- Ⅱ评分呈正相关性（r=0.548，0.523，均P<0.05）。SYNTAX- Ⅱ评分、MORN4 mRNA，CD40L mRNA表达是影响急性STEMI患者PCI 术后发生MACE的独立危险因素（Wald χ2=24.426，4.569，3.038，均P<0.05）。当MORN4，CD40L 截断值分别取1.79 和1.52 时，两者联合预测MACE 发生的AUC（95%CI）、敏感度、特异度优于单一指标预测（Z=1.972，2.393，均P ＜ 0.05）。结论 急性STEMI 患者PCI 术后检测循环细胞外囊泡中MORN4，CD40L 表达对评估冠脉病变程度及MACE 发生具有积极意义，联合检测MORN4 和CD40L 对预测术后MACE 发生临床价值较高，可作为评估患者近期预后的有效分子标志物。
Abstract:
Objective To investigate the relationship between expression levels of membrane occupation and recognition nexus of linker domain protein 4(MORN4) and cluster differentiation 40 ligand(CD40L) in peripheral blood extracellular vesicles after percutaneous coronary intervention (PCI) and SYNTAX-II score and prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods Retrospective analysis of 268 patients with acute STEMI who underwent PCI in the Department NO 2. of Cardiology, Affiliated Hospital of Shaanxi University of Chinese Medicine from June 2020 to May 2023. Patients were divided into MACE group and non MACE group based on major adverse cardiovascular events (MACE) occurred during the 1-year follow-up period. Quantitative real-time PCR (RT-qPCR) was used to detect the mRNA expression levels of MORN4 and CD40L in circulating extracellular vesicles in peripheral blood of the two groups. The clinical data and expressions of MORN4 and CD40L were compared between the two groups. Pearson correlation analysis of MORN4, CD40L and SYNTAX- Ⅱ scores. Multi-factor Logistics regression model was used to analyze the risk factors of MACE after PCI. The receiver operating characteristic (ROC) curve was plotted, the area under curve (AUC) was calculated, and the value of MORN4 and CD40L expression levels in predicting the occurrence of MACE was analyzed. Results Within 1 year after surgery, 75 patients developed MACE. Clinical data comparison showed that the MACE group had higher numbers of diseased vessel branches, stent numbers, and SYNTAX-II scores compared to the non MACE group，and the differences were statistically significant (χ2/t=4.451，2.625，11.553，all P<0.05).The expression levels of MORN4 mRNA（2.16±0.54）and CD40L mRNA（1.87±0.25）in the MACE group were higher than those in the non-MACE group（1.24±0.31，1.13±0.19），and the differences were statistically significant（t=17.429，26.092，all P<0.05）. Pearson correlation analysis showed，MORN4 and CD40L expression were positively correlated with SYNTAX-II score(r=0.548，0.523，all P<0.05). SYNTAX-II score， MORN4 and CD40L expression were independent risk factors for MACE after PCI in patients with acute STEMI (Wald χ2=24.426，4.569，3.038，all P<0.05). When the cutoff values of MORN4 and CD40L were set to 1.79 and 1.52, respectively, their combined prediction of AUC（95%CI）sensitivity and specificity for MACE occurrence was superior to single indicator prediction (Z=1.972, 2.393, all P<0.05). Conclusion The detection of MORN4 and CD40L expression in circulating extracellular vesicles of acute STEMI patients after PCI has a positive significance in evaluating the degree of coronary artery disease and the occurrence of MACE. The combined detection of MORN4 and CD40L has high clinical value in predicting the occurrence of MACE after surgery and can be used as effective molecular markers for evaluating the short-term prognosis of patients.

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备注/Memo

备注/Memo:
作者简介：董佳（1987-），男，硕士，主治医师，研究方向：心血管疾病诊治， E-mail：DJ870922@163.com。
通讯作者：寇拉娣，女，主任医师，研究方向：心血管疾病诊治，E-mail:446452435@qq.com。
更新日期/Last Update: 2025-07-15