退行性心脏瓣膜病患者血清LP(a)、OPN、IRF-4表达及其临床意义

Expressions and clinical significance of serum LP(a),OPN,IRF⁃4 in patients with degenerative heart valve disease

目的探讨退行性心脏瓣膜病(DHVD)患者血清脂蛋白(a)[LP(a)]、骨桥蛋白(OPN)、干扰素调节因子⁃4(IRF⁃4)表达及其临床意义。方法选取本院120例DHVD患者作为研究组,同期健康体检者115例作为对照组。比较两组血清LP(a)、OPN、IRF⁃4 mRNA水平,分析DHVD发病的影响因素及血清各指标诊断DHVD的价值,并比较治疗3个月后不同疗效患者血清LP(a)、OPN、IRF⁃4 mRNA水平及心功能指标[左心室射血分数(LVEF)、心脏指数(CI)]水平,分析各血清各指标与心功能指标相关性。结果多瓣膜病变患者组、单瓣膜病变患者组及健康体检者血清LP(a)、OPN、IRF⁃4 mRNA水平比较(F=47.427,66.514,36.432),差异有统计学意义(P<0.05);冠心病、吸烟史、高血压、血清LP(a)、OPN、IRF⁃4 mRNA是DHVD发病的重要影响因素(P<0.05);血清各指标中,LP(a)诊断DHVD的曲线下面积(AUC)最大,为0.802,截断值敏感度为70.00%,特异度为86.09%;治疗3个月后,显效者血清LP(a)、OPN水平低于有效者、无效者,IRF⁃4 mRNA水平及LVEF、CI高于有效者、无效者(P<0.05);血清LP(a)、OPN与LVEF、CI存在显著负相关关系,IRF⁃4 mRNA与LVEF、CI存在显著正相关关系,差异有统计学意义(P<0.05)。结论DHVD患者血清LP(a)、OPN、IRF⁃4 mRNA表达异常,是DHVD发生的重要影响因素,在DHVD诊断及评估疗效方面具有较高应用价值。

Objective To investigate the expression of serum lipoprotein(a)[LP(a)],osteopontin(OPN),interferon regulatory factor⁃4(IRF⁃4)in patients with degenerative heart valve disease(DHVD)and its clinical significance.Methods 120 patients with DHVD in our hospital were selected as the study group,and 115 healthy people who were examined during the same period were used as the control group.The serum LP(a),OPN,IRF⁃4 mRNA levels were compared between the two groups.The influencing factors of the incidence of DHVD and the diagnostic value of serum indicators for DHVD were analyzed.The levels of serum LP(a),OPN,IRF⁃4 mRNA and cardiac function indexes[left ventricular ejection fraction(LVEF),cardiac index(CI)]of patients with different therapeutic effects after 3 months of treatment were compared.The correlation between serum indexes and cardiac function indexes was evaluated.Results The serum LP(a),OPN,IRF⁃4 mRNA levels have significant difference in the patients with multi⁃valvular disease and with single⁃valvular disease,and healthy people(F=47.427,66.514,36.432),(P<0.05).Coronary heart disease,smoking history,high blood pressure,serum LP(a),OPN,and IRF⁃4 mRNA are important influencing factors for the onset of DHVD(P<0.05).Coronary heart disease,smoking history,hypertension,serum LP(a),OPN,IRF⁃4 mRNA are important influencing factors of DHVD(P<0.05).Among the various serum indexes,the area under the curve(AUC)for diagnosis of DHVD by LP(a)is the largest,0.802,the sensitivity of the cutoff value is 70.00%,and the specificity is 86.09%.After the treatment for 3 months,the serum LP(a)and OPN levels of the effective patients were lower than those of the effective and ineffective patients,and the IRF⁃4 mRNA levels and LVEF,CI were higher than those of the effective and ineffective(P<0.05).The serum LP(a)and OPN had negative correlation with LVEF and CI.Intersetingly,theIRF⁃4 mRNA had positive correlation with LVEF and CI(P<0.05).Conclusion The abnormal expression of serum LP(a),OPN and IRF⁃4 mRNA in DHVD patients is an important influencing factor of DHVD,and has high application value in the diagnosis and evaluation of DHVD.