血清肺腺癌转移相关转录本1水平与老年心力衰竭合并肺炎患者预后的相关性及预测分析

Correlation and predictive value of serum MALAT1 level and prognosis of elderly patients with heart failure and pneumonia

目的探讨血清肺腺癌转移相关转录本1(MALAT1)水平与老年心力衰竭合并肺炎患者预后的相关性及其预测价值。方法选取2018年2月至2019年6月我院就诊的206例老年心力衰竭合并肺炎患者为本次研究对象,共纳入有效病例197例并完成随访,根据其预后情况分为预后不良组(60例)和对照组(137例),收集两组患者临床资料、实验室资料和影像学资料,经实时荧光定量逆转录聚合酶链反应(QRTPCR)测定检查所有患者血清中MALAT1表达,对比两组患者临床资料,多因素logistic回归方程分析老年心力衰竭合并肺炎患者预后的影响因素,绘制工作特征曲线(ROC)评估MALAT1对老年心力衰竭合并肺炎患者预后的预测价值。结果预后不良组的C-反应蛋白(CRP)[(96.45±8.97)mg/L比(24.01±2.60)mg/L]、血清淀粉样蛋白A(SAA)[(26.76±6.84)mg/L比(20.54±3.21)mg/L]、N末端B型利钠肽前体(NT-proBNP)[(0.07±0.01)比(0.06±0.01)pg/L]均高于对照组;左心室射血分数(LVEF)[(46.73±8.20)%比(51.33±8.45)%]和氧合指数(PaO2/FiO2)[(146.79±30.89)mm Hg比(156.21±30.56)mm Hg]低于对照组(P<0.05);QRT-PCR结果显示:与对照组相比,预后不良组MALAT1[(4.15±1.06)比(2.24±0.53)]表达显著增加(P<0.05);多因素logistic回归方程分析显示,SAA(OR=1.491)、LVEF(OR=0.904)、PaO2/FiO2(OR=0.916)和MALAT1(OR=2.421)均为影响老年心力衰竭合并肺炎患者的预后因素;ROC曲线分析显示,MALAT1早期预测老年心力衰竭合并肺炎患者预后的AUC为0.871,高于SAA、LVEF和PaO2/FiO2(P<0.05)。结论SAA、LVEF和PaO2/FiO2均是老年心力衰竭合并肺炎患者预后的预测因素,同时MALAT1可作为预测老年心力衰竭合并肺炎患者预后的标志物。

Objective To investigate the correlation between the level of serum metastatic related lung adenocarcinoma transcript 1(MALAT1)and the prognosis of elderly patients with heart failure and pneumonia.Methods The clinical data of 206 elderly patients with heart failure and pneumonia who were treated from February 2018 to June 2019 were selected.A total of 197 patients completed the follow-up.According to their prognosis,they were divided into the poor prognosis group(60 cases)and the control group(137 cases).The clinical data,laboratory data and images of the two groups were collected.Then qPCR assay was used to check the expression of MALAT1 in the serum of all patients.The data of the two groups of patients were compared and analyzed;the different indicators were brought into the multi-factor logistic regression equation to analyze the risk factors that affected the condition and prognosis of elderly patients with heart failure and pneumonia and the working characteristic curve(ROC)was drawn to evaluate the effect of MALAT1 on elderly patients with heart failure and pneumonia.Results The poor prognosis group was higher in CRP[(96.45±8.97)mg/L vs.(24.01±2.60)mg/L],SAA[(26.76±6.84)mg/L vs.(20.54±3.21)mg/L]and NT-pro BNP[(0.07±0.01)vs.(0.06±0.01)pg/L]than the control group;the left ventricular ejection fraction LVEF(46.73±8.20 vs.51.33±8.45)%and PaO2/FiO2(146.79±30.89 vs.156.21±30.56)mm Hg were lower than the control group(P<0.05);QRT-PCR results showed that the expression of MALAT1(4.15±1.06 vs.2.24±0.53)in the poor prognosis group significantly increased compared with the control group(P<0.05);by Logistic regression equation analysis showed that SAA(OR=1.491),LVEF(OR=0.904)and PaO2/FiO2(OR=0.916)MALAT1(OR=2.421)all were the independent risk factors that affect the prognosis of the elderly patients with heart failure and pneumonia;further analysis by ROC curve showed that:AUC of MALAT1 early predicting the prognosis of elderly patients with heart failure and pneumonia was 0.871,which was higher than SAA,LVEF and PaO2/Fi O2(P<0.05).Conclusion SAA,LVEF and PaO2/FiO2 all are the independent risk factors that affect the prognosis of elderly patients with heart failure and pneumonia.MALAT1 can be used as a marker to predict the condition and prognosis of elderly patients with heart failure and pneumonia.