急性ST段抬高型心肌梗死患者血浆微小核糖核酸-208a水平对并发急性心力衰竭的预测价值

Predictive value of plasma miR-208a for acute heart failure after acute ST-elevated myocardial infarction

目的:探讨血清微小核糖核酸-208a(miR-208a)表达水平对急性ST段抬高型心肌梗死(STEMI)患者并发急性心力衰竭的预测关系。方法:连续性收集2018年1月至2019年6月,就诊于我科的152例急性STEMI患者纳入病例组,并随机选择同期在我院行健康体检的志愿者60例为对照组。根据发病48 h内是否发生急性心力衰竭(AHF)将病例组分为AHF亚组和非AHF亚组。采用实时荧光定量PCR(RT-qPCR)法检测血浆miR-208a的相对表达水平。结果:病例组血浆miR-208a相对表达水平显著高于对照组(Z=10.919,P=0.000)。AHF亚组血浆miR-208a相对表达水平显著高于非AHF亚组(Z=9.573,P=0.000)。Pearson相关性分析结果显示,病例组患者血浆miR-208a相对表达水平与BNP、hsCRP和cTnI均呈正相关关系(r=0.612,P=0.000;r=0.447,P=0.000;r=0.378,P=0.000)。二分类Logistic回归分析结果显示血浆miR-208a相对表达水平是急性STEMI患者并发AHF的危险因素(OR=2.118,95%CI 1.127~3.982,P=0.007)。血浆miR-208a预测AHF的AUC为0.896(0.844,0.948),cut-off值为32.00,对应的敏感性和特异性分别为88.4%和83.3%。结论:急性STEMI患者血浆miR-208a表达水平显著升高,且可能是并发AHF的危险因素。

Objective:To investigate the predictive value of plasma miR-208 a for acute heart failure(AHF)after acute ST-elevated myocardial infarction(STEMI).Methods:152 acute STEMI patients and 60 controls who hospitalized in our hospital from January 2018 to June 2019 were selected into this study as case group and control group,respectively.According to the occurrence of AHF during the initial 48 hours after the onset of disease,the patients of case group were divided into AHF subgroup and non-AHF subgroup.Real-time quantitative PCR(RT-qPCR)was used to determine the expression of miR-208 a in plasma.Results:The plasma miR-208 a level in case group was far higher than that in control group(Z=10.919,P=0.000).The plasma miR-208 a level in AHF subgroup was far higher than that in non-AHF subgroup(Z=9.573,P=0.001).Pearson correlation analysis showed that there was a positive correlation between plasma miR-208 a and B-type BNP,hsCRP,cTnI(r=0.612,P=0.000;r=0.447,P=0.000;r=0.378,P=0.000).Binary logistics regression analysis showed that plasma miR-208 a was independent risk factor for AHF in acute STEMI patients(OR=2.118,95%CI:1.127-3.982,P=0.007).The area under the ROC curve of miR-208 a predicting for AHF was 0.896(0.844,0.948).When the cut-off value was set at 32.00,the Youden index reached the maximum with a sensitivity of 0.884 and a specificity of 0.833.Conclusions:Plasma miR-208 a level was significantly increased in acute STEMI patients,and the higher admission plasma miR-208 a maybe an independent predictor of AHF in acute STEMI patients.