【摘要】 經皮冠狀動脈介入治療(PCI)是冠狀動脈粥樣硬化的常用治療手段。支架內再狹窄(ISR)是植入支架后較為高發的并發癥。微RNA(microRNA,miRNA)可以作為再狹窄診斷和治療的生物標志物和靶標,預防或減少再狹窄的發生。本文綜述了ISR的病理生理機制,介紹了幾種miRNA在ISR的功能和調節過程,闡釋了其在調控血管平滑肌細胞(VSMC)和內皮細胞(EC)的表型、增殖和遷移中的作用。為針對miRNA的ISR的治療和預防策略提出臨床參考,從而指導治療方案。
【關鍵詞】 微RNA 支架內再狹窄 內皮細胞 血管平滑肌細胞 經皮冠狀動脈介入治療
The Role and Mechanisms of microRNA in In-stent Restenosis/LIU Xingjian, WANG Jinhang, ZHANG Bolun, LIU Rundong, WANG Chuan. //Medical Innovation of China, 2024, 21(27): -188
[Abstract] Percutaneous coronary intervention (PCI) is a common treatment for coronary atherosclerosis. In-stent restenosis (ISR) is a relatively frequent complication following stent implantation. MicroRNA (miRNA) can serve as biomarkers and targets for the diagnosis and treatment of restenosis, potentially preventing or reducing its occurrence. This article reviews the pathophysiological mechanisms of ISR, presents the functions and regulatory processes of several miRNA in ISR, and elucidates their roles in regulating the phenotypes, proliferation, and migration of vascular smooth muscle cells (VSMC) and endothelial cells (EC). This article offers clinical insights into miRNA targeted therapeutic and preventive strategies for ISR, thereby guiding treatment protocols.
[Key words] microRNA In-stent restenosis Endothelial cell Vascular smooth muscle cell Percutaneous coronary intervention
First-author's address: Capital Medical University Yanjing Medical College, Beijing 101300, China
doi:10.3969/j.issn.1674-4985.2024.27.042
①首都醫科大學燕京醫學院 北京 101300
②首都醫科大學生物醫學工程學院 北京 100069
③中國醫學科學院北京協和醫院心內科 北京 100730
通信作者:王川
心血管疾病(cardiovascular disease,CVD)每年導致全球約1 790萬人死亡,占全球死亡總數的近三分之一[1-2]。其中冠狀動脈粥樣硬化性心臟病(coronary atherosclerotic heart disease,CAD)最常見。因其高發病率及高死亡率成為公共衛生的重大挑戰[3]。臨床上常用的CAD治療方法包括藥物治療、冠狀動脈旁路移植術(coronary artery bypass grafting,CABG)和經皮冠狀動脈介入治療(percutaneous coronary intervention,PCI)[4]。PCI術因其創傷小、恢復快的優點,已成為治療CAD最常見的手段[3]。在行PCI術植入支架后,可能發生支架內再狹窄(in-stent restenosis,ISR)。其根據研究方式和支架類型的不同發生率為5%~10%[5]。球囊擴張和支架植入引起的局部血管損傷會破壞血管生理穩態,使ISR患者再次出現不穩定型心絞痛和心肌梗死(myocardial infarction,MI)等臨床癥狀[6]。
非編碼RNA(noncoding RNA,ncRNA)在基因組中被轉錄,但不能被進一步翻譯成蛋白質,在ISR的發展形成過程中具有重要意義[7]。……