血浆microRNA-590水平与急性心肌梗死后室性心律失常的关系

Relationship between plasma level of micro RNA-590 and ventricular arrhythmia after acute myocardial infarction

目的探讨血浆microRNA-590(miR-590)水平与急性心肌梗死(AMI)患者发生室性心律失常的关系。方法连续选取2018年8月至2019年12月在安徽省第二人民医院心内科住院治疗的AMI患者240例,根据是否发生室性心律失常分为室性心律失常组(146例)和无室性心律失常组(94例),收集患者临床资料,运用实时荧光定量PCR检测患者血浆miR-590水平,分析血浆miR-590水平与Lown分级关系,分析AMI患者发生室性心律失常的影响因素,评估血浆miR-590水平对AMI患者发生室性心律失常的辨别能力。结果室性心律失常组与无室性心律失常组的性别、年龄、吸烟史、高血压病、糖尿病、血脂异常、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、血肌酐和空腹血糖比较,差异无统计学意义(P>0.05);与无室性心律失常组比较,室性心律失常组的Killip心功能分级较差(Killip分级>2级:27.40%比12.77%,P<0.05),左心室射血分数较低[(46.49±11.68)%比(52.44±9.77)%,P<0.05];室性心律失常组血浆miR-590水平高于无室性心律失常组[(1.38±0.54)比(1.01±0.30),P<0.05];Lown分级1、2、3、4、5级室性心律失常患者血浆miR-590水平逐渐升高[(1.02±0.47)、(1.22±0.49)、(1.45±0.44)、(1.69±0.43)、(2.00±0.35)],差异有统计学意义(P均<0.05);Pearson相关分析显示室性心律失常患者血浆miR-590水平与Lown分级呈显著正相关(r=0.569,P<0.05);多因素logistic回归分析显示血浆miR-590水平升高是AMI患者发生室性心律失常的独立危险因素(OR=7.137,95%CI 2.876~17.709,P<0.05);ROC曲线分析显示血浆miR-590水平判断AMI患者发生室性心律失常的曲线下面积为0.714(95%CI 0.650~0.778,P<0.05),取miR-590的最佳截断值为1.445时,其判断AMI患者发生室性心律失常的敏感度为46.60%,特异度为92.60%。结论AMI患者血浆miR-590水平的升高可能预示发生室性心律失常风险的增加。

Objective To explore the relationship between plasma level of micro RNA-590(mi R-590)and ventricular arrhythmia in patients with acute myocardial infarction(AMI).Methods A total of 240 consecutive patients with AMI who were hospitalized in the department of Cardiology of Anhui No.2 Provincial People’s Hospital from August 2018 to December 2019 were divided into ventricular arrhythmia group(n=146)and nonventricular arrhythmia group(n=94)according to whether ventricular arrhythmia occurred.The clinical data were collected and the plasma level of mi R-590 was detected by real-time quantitative PCR.The relationship between plasma level of mi R-590 and Lown grade was analyzed and the influencing factors of ventricular arrhythmia were analyzed and the role of plasma level of mi R-590 in distinguishing ventricular arrhythmia was evaluated.Results There was no significant difference in gender,age,smoking history,hypertension,diabetes,dyslipidemia,total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein,serum creatinine and fasting blood glucose between the two groups(P>0.05).Compared with non-ventricular arrhythmia group,the Killip cardiac function classification was worse(Killip classification>2:27.40%vs.12.77%,P<0.05),and the left ventricular ejection fraction was lower[(46.49±11.68)%vs.(52.44±9.77)%,P<0.05]in ventricular arrhythmia group.The plasma level of mi R-590 in ventricular arrhythmia group was higher than that in non-ventricular arrhythmia group[(1.38±0.54)vs.(1.01±0.30),P<0.05].The plasma level of mi R-590 in ventricular arrhythmia patients with Lown grade 1,2,3,4 and 5 increased gradually[(1.02±0.47),(1.22±0.49),(1.45±0.44),(1.69±0.43),(2.00±0.35)]and the differences were statistically significant(P<0.05 in all).Pearson correlation analysis showed that plasma level of mi R-590 was significantly positively correlated with Lown grade in patients with ventricular arrhythmia(r=0.569,P<0.05).Multivariate logistic regression analysis showed that the elevated plasma mi R-590 level was an independent risk factor for ventricular arrhythmia in patients with AMI(OR=7.137,95%CI:2.876-17.709,P<0.05).ROC curve analysis showed that the area under the curve of plasma mi R-590 level in distinguishing ventricular arrhythmia in patients with AMI was 0.714(95%CI:0.650-0.778,P<0.05);when the optimal threshold value of mi R-590 was 1.445,the sensitivity and specificity were 46.60%and 92.60%,respectively.Conclusions Elevated plasma mi R-590 level in patients with AMI may indicate an increased risk of ventricular arrhythmia.