老年心力衰竭患者外周血miR-423-5p表达水平及与心室重构的关系探讨

Relationship between expression of peripheral blood miR-423-5p and ventricular remodeling in elderly patients with heart failure

目的探讨老年心力衰竭患者外周血miR-423-5p表达水平以及与心室重构的关系。方法选择2016年2月至2018年4月于南阳市第二人民医院心内科就诊的老年心力衰竭(HF)患者187例,参照ACC/AHA指南关于心衰分期的标准,将患者分为心衰A期(A组,n=91例)和心衰B期(B组,n=96例),另外选取46例健康人群作为C组。收集各组临床资料、血液生化指标、心脏超声检查以及外周血mi R-423-5p表达水平的差异。采用多元Logistic回归模型分析心室重构的影响因素。采用受试者工作特征(ROC)曲线确定miR-423-5p对前心衰患者的筛选价值。结果 A组和B组患者一般临床资料和血液生化指标基本一致(P>0.05),但是B组患者左室舒张末径(LVEDD)、舒张末室间隔厚度(IVSD)、舒张末左室后壁厚度(PWD)、左室质量指数(LVMI)、左室相对室壁厚度(RWT)均高于A组患者(P<0.05)。C组受试者外周血mi R-423-5p相对表达量明显低于A组和B组患者(P<0.05);同时B组患者外周血mi R-423-5p相对表达量明显高于A组患者(P<0.05)。经miR-423-5p对前心衰患者的筛选ROC曲线分析,曲线下的面积为0.721(95%CI:0.634～0.797),截断值为1.27(P<0.05)。经多元Logistic回归分析,外周血miR-423-5p是影响心室重构的独立危险因素(OR=2.385,95%CI:1.298～4.382,P<0.05)。结论外周血miR-423-5p可用于筛查老年心衰前期人群,且与心室重构呈显著、独立的相关性。

Objective To investigate the relationship between expression of peripheral blood miR-423-5p and ventricular remodeling in elderly patients with heart failure(HF).Methods The patients(n=187)were chosen from the Second People’s Hospital of Nanyang City from Feb.2016 to Apr.2018,and divided,according to ACC/AHA Guideline,into HF group A(n=91)and group B(n=96),and other healthy controls were chosen into group C(n=46).The clinical materials were collected and differences in blood biochemical indexes,cardiac ultrasonography and expression of peripheral blood miR-423-5p were analyzed in 2 groups.The influence factors on ventricular remodeling were analyzed by using multiple Logistic regression models.The value of miR-423-5p for screening pre-HF patients was determined by using curve of receiver operating characteristic(ROC).Results The general clinical materials and blood biochemical indexes were basically the same between group A and group B(P>0.05),while left ventricular end-diastolic inner diameter(LVEDd),interventricular septum thickness of end-diastole(IVSTd),left ventricular posterior wall thickness at end diastole(LVPWTd),left ventricular mass index(LVMI),left ventricular relative wall thickness(RWT)were all higher in group B than those in group A(P<0.05).The expression of peripheral blood miR-423-5p was significantly lower in group C than that in groups A and B(P<0.05),and at the same time it was significantly higher in group B than that in group A(P<0.05).The curve of ROC analysis on miR-423-5p for screening pre-HF patients showed that area under curve(AUC)was 0.721(95% CI:0.634~0.797)and cut-off value was 1.27(P<0.05).The results of Logistic regression analysis showed that peripheral blood miR-423-5p was an independent risk factor influencing on ventricular remodeling(OR=2.385,95% CI:1.298~4.382,P<0.05).Conclusion The peripheral blood miR-423-5p can be used in screening of elderly population with pre-HF,which is significantly and independently correlated to ventricular remodeling.