循环miR-26b水平变化与老年高血压患者左心室肥厚及心功能的关系

The relationship between the changes of circulating miR-26b and left ventricular hypertrophy and cardiac function in elderly patients with hypertension

目的分析循环miR-26b水平变化与老年高血压患者左心室肥厚及心功能的关系。方法选取2017年1月—2019年10月蚌埠医学院第二附属医院心内科诊治老年高血压患者132例,检测患者循环miR-26b水平,以其相对表达量的中位数作为临界值,分为miR-26b低水平组(对照组,n=76)和miR-26b高水平组(观察组,n=56)。比较2组患者的生化指标、心脏超声指标及NYHA心功能分级,分析miR-26b与各超声心动图参数的相关性;多因素Logistic回归分析老年高血压患者发生左心室肥厚的影响因素;ROC曲线预测循环miR-26b对老年高血压患者左心室肥厚的诊断价值。结果与对照组相比,观察组室间隔厚度(IVST)、左心室后壁厚度(LVPWT)、左心室质量指数(LVMI)及左心室肥厚(LVH)病例数均降低(t=12.031、12.003、12.738,χ^2=65.558,P均=0.000),E/A值升高(t=8.219,P=0.000)。循环miR-26b水平与IVST、LVPWT和LVMI均呈负相关(r=-0.493、-0.526、-0.789,P均<0.001),与E/A值呈正相关(r=0.421,P<0.001)。对照组心功能减退比例显著高于观察组(χ^2=42.861,P=0.000)。年龄、IVST、LVPWT及LVMI增加是导致老年高血压患者左心室肥厚发生的独立危险因素(P<0.05);miR-26b水平升高则是保护因素(P<0.01)。循环miR-26b水平诊断老年高血压的ROC曲线下面积为0.836,最佳临界值为8.83,敏感度为81.4%,特异度为78.9%,约登指数为0.603。结论循环miR-26b水平与老年高血压患者左心室肥厚呈负相关,与左室舒张功能呈正相关,是老年高血压患者发生左心室肥厚伴舒张功能不全的保护因素,同时可作为潜在的生物标志物用于老年高血压患者左心室肥厚的诊断。

Objective To analyze the relationship between the changes of circulatory miR-26b and left ventricular hypertrophy and cardiac function in elderly patients with hypertension.Methods:From January 2017 to October 2019,132 elderly patients with hypertension were treated in the Department of Cardiology,the Second Affiliated Hospital of Bengbu Medical College.The level of miR-26b was measured.Taking the median of relative expression as the critical value,miR-26b was divided into low level group(control group,n=76)and high-level group(observation group,n=56).The biochemical indexes,echocardiographic indexes and NYHA cardiac function grades of the two groups were compared,and the correlation between miR-26b and echocardiographic parameters was analyzed.Multivariate logistic regression was used to analyze the influencing factors of left ventricular hypertrophy in elderly patients with hypertension.ROC curve predicts the value of circulatory miR-26b in the diagnosis of left ventricular hypertrophy in elderly patients with hypertension.Results Compared with the control group,IVST,LVPWT,LVMI and LVH decreased(t=12.031,12.003,12.738,χ^2=65.558,P=0.000),and E/A increased(t=8.219,P=0.000).The circulating miR-26b level was negatively correlated with IVST,LVPWT and LVMI(r=-0.493,-0.526,-0.789,P<0.001),and positively correlated with E/A(r=0.421,P<0.001).The proportion of cardiac dysfunction in the control group was significantly higher than that in the observation group(χ^2=42.861,P=0.000).The increase of age,IVST,LVPWT and LVMI were independent risk factors(P<0.05),and the increase of miR-26b was protective factor(P<0.01).The area under ROC curve was 0.836,the best critical value was 8.83,the sensitivity was 81.4%,the specificity was 78.9%,and the Youden index was 0.603.Conclusion The level of circulating miR-26b has a negative correlation with left ventricular hypertrophy and a positive correlation with left ventricular diastolic function.It is a protective factor of left ventricular hypertrophy and diastolic dysfunction in elderly patients with hypertension.It can also be used as a potential biomarker for the diagnosis of left ventricular hypertrophy in elderly patients with hypertension.