血清miR-150对急性心肌梗死后发生收缩功能障碍的预测价值

Clinical value of serum miR-150 level in predicting systolic dysfunction after acute myocardial infarction

目的探讨血清中循环miRNA在急性心肌梗死(AMI)后对发生心室收缩功能障碍的预测价值研究。方法纳入接受经皮冠状动脉介入治疗(PCI)的174例AMI患者。以出院后1年时的左心室射血分数(LVEF)<50%作为心力衰竭(HF)诊断标准,将AMI患者分为HF组(56例)和非HF组(118例)。通过实时荧光定量PCR测量血浆中循环miR-150、miR-34a、miR-133a、miR-192、miR-194和miR-208b的表达水平。通过ROC曲线确定循环miR-150对HF的诊断价值和阈值,并通过多因素Logistic回归分析确定影响HF的独立危险因素。结果 HF患者的入院时脑钠肽(BNP)显著高于非HF患者(t=8.397,P <0.01)。与非HF患者相比,HF患者出院后1年时的LVEF降低、但左心室舒张末期内径(LVIDD)显著升高。HF患者的循环miR-150显著高于非HF患者(P <0.05),但其他循环miRNA差异无统计学意义(P> 0.05)。AMI患者的循环miR-150水平与1年后LVEF呈显著负相关(r=-0.539,P <0.01)。ROC曲线分析显示,循环miR-150对HF预测价值AUC为0.75,阈值为0.60,灵敏度为84.12%、特异度为77.43%。多因素Logistic回归分析显示,循环miR-150>0.60(OR=1.634,95%CI=1.253~2.096,P <0.01)和入院时LVEF<57.00%(OR=1.275,95%CI=1.021~1.482,P <0.05)是影响HF的危险因素。结论血浆循环miR-150是预测AMI后HF发生的新型生物学标志物,对预测HF和制定临床治疗方案具有重要的指导价值。

Objective To investigate the predictive value of serum circulating miRNA for the development of ventricular systolic dysfunction after acute myocardial infarction(AMI).Methods 174 patients with AMI who underwent percutaneous coronary intervention(PCI)were enrolled.According to the diagnostic criteria of heart failure(HF)by the left ventricular eject fraction(LVEF)<50%at one year after discharge,AMI patients were divided into HF group(56 cases)and non-HF group(118 cases).The real-time fluorescent quantitation PCR was performed to measure the expression levels of circulating miR-150,miR-34 a,miR-133 a,miR-192,miR-194 and miR-208 b in plasma.The diagnostic value and threshold of circulating miR-150 for HF were determined by ROC curve.The multivariate logistic regression was used to identify independent risk factors that affect HF.Results The BNP in patients with HF was significantly higher than that of non-HF patients(t=8.397,P<0.01).Compared with nonHF patients,LVEF decreased at 1 year after discharge and LVIDD was significantly increased in HF patients.The circulating miR-150,miR-34 a,miR-133 a,miR-192,miR-194 and miR-208 b in patients with AMI were significantly higher than those in healthy controls(P<0.05).The circulating miR-150 in patients with HF was significantly higher than that in non-HF patients(P<0.05),but there was no significant difference in other circulating miRNAs(P>0.05).The circulating miR-150 level in patients with AMI was negatively correlated with LVEF after 1 year(r=-0.539,P<0.01).ROC curve analysis showed that the predicted value of cyclic miR-150 for HF was 0.75,with the threshold of 0.60,sensitivity of 84.12%,and specificity of 77.43%.Multivariate Logistic regression analysis showed that circulating miR-150>0.60(OR=1.634,95%CI:1.253-2.096,P<0.01)and LVEF<57.00%at admission(OR=1.275,95%CI:1.021-1.482,P<0.05)were risk factors for HF.Conclusion Plasma circulating miR-150 is a novel biomarker for predicting HF after AMI,and has important guiding value for predicting HF and developing clinical treatment options.