高血压患者血管内皮功能障碍的影响因素分析及血清miR-297a、miR-143水平对其的预测价值

Analysis of influencing factors of vascular endothelial dysfunction in patients with hypertension and the predictive value of serum miR-297a and miR-143 levels

目的探讨高血压患者血管内皮功能障碍的发生情况及影响因素,以及血清微小RNA(miR)-297a、miR-143水平用于预测高血压患者发生血管内皮功能障碍的价值。方法将2018年3月至2020年1月于该院接受治疗的69例高血压患者纳入研究,依据治疗期间是否发生血管内皮功能障碍分为发生组与未发生组。调查纳入研究者的基线资料,于开始接受治疗当天早晨检测血清成纤维细胞生长因子23(FGF23)、基质金属蛋白酶-14(MMP-14)、miR-297a、miR-143水平,分析上述指标与高血压患者发生血管内皮功能障碍的关系。结果全部69例高血压患者血管内皮功能障碍的发生率为26.09%(18/69)。两组间年龄、性别、高血压家族史、吸烟史、合并糖尿病情况、酗酒史、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿酸(UA)、纤维蛋白原(FIB)、脂蛋白a(Lp-a)、载脂蛋白A(ApoA)、载脂蛋白B(ApoB)、载脂蛋白E(ApoE)、磷脂(PLIP)比较,差异均无统计学意义(P>0.05);发生组血清FGF23、MMP-14水平高于未发生组,miR-297a、miR-143水平低于未发生组,差异均有统计学意义(P<0.05);高血压患者血清miR-297a水平与miR-143水平呈正相关(r=0.548,P<0.05);Logistic回归分析显示,血清FGF23、MMP-14是高血压患者发生血管内皮功能障碍的危险因素(OR>1,P<0.05),血清miR-297a、miR-143是高血压患者发生血管内皮功能障碍的保护因素(OR<1,P<0.05);绘制受试者工作特征(ROC)曲线,血清miR-297a、miR-143水平单独及联合检测用于预测高血压患者发生血管内皮功能障碍的曲线下面积(AUC)均大于0.80,预测价值较理想,血清miR-297a、miR-143的cut-off值分别为0.585、1.045。结论高血压患者发生血管内皮功能障碍可能与治疗前血清miR-297a、miR-143低水平有关,可考虑把检测高血压患者血清miR-297a、miR-143水平作为预测患者血管内皮功能障碍发生的方法。

Objective To observe the occurrence and influencing factors of vascular endothelial dysfunction in patients with hypertension,and the predictive value of serum miR-297a and miR-143 levels.Methods A total of 69 patients with hypertension treated in the hospital from March 2018 to January 2020 were enrolled in the study.According to whether vascular endothelial dysfunction occurred during treatment,those patients were divided into occurrence group and a nonoccurrence group.Investigated the general information of the two groups and tested the serum levels of fibroblast growth factor 23(FGF23),matrix metalloproteinase-14(MMP-14),miR-297a and miR-143 in the morning at the start of treatment.Analyzed the relationship between serum miR-297a,miR-143 levels and vascular endothelial dysfunction in patients with hypertension.Results Among all the 69 patients with hypertension,18 had vascular endothelial dysfunction,the incidence rate was 26.09%(18/69);age,gender,family history of hypertension,smoking history,cases with diabetes,history of alcohol abuse,TC,TG,HDL-C,LDL-C,UA,FIB,Lp-a,ApoA,ApoB,ApoE,Phospholipid(PLIP)were compared between the two groups and the differences were not statistically significant(P>0.05);serum FGF23 and MMP-14 levels in the occurrence group were higher than those in the nonoccurrence group,and the levels of miR-297a and miR-143 were lower than those in the nonoccurrence group,the differences were statistically significant(P<0.05);the level of serum miR-297a in hypertensive patients was positively correlated with the level of miR-143(r=0.548,P<0.05);Logistic regression analysis showed that serum FGF23 and MMP-14 were risk factors for vascular endothelial dysfunction in hypertensive patients(OR>1,P<0.05),serum miR-297a and miR-143 are protective factors for vascular endothelial dysfunction in patients with hypertension(OR<1,P<0.05);the AUC of serum miR-297a,miR-143 which were used to predict the occurrence of vascular endothelial dysfunction in patients with hypertension is greater than 0.80,and the predictive value was ideal.The cut-off values of serum miR-297a and miR-143 were 0.585 and 1.045,respectively.Conclusion Vascular endothelial dysfunction in patients with hypertension may be related to the low levels of serum miR-297a and miR-143 before treatment.The detection of serum miR-297a and miR-143 levels in hypertensive patients can be considered as a method to predict the occurrence of vascular endothelial dysfunction.