持续性房颤患者microRNA-328与心房重构的相关性及螺内酯的干预作用

Correlation between microRNA-328 and atrial remodeling in patients with persistent atrial fibrillation and intervention effect of spironolactone

目的通过观察持续性房颤患者microRNA-328(miRNA-328)的表达水平及左心房内径(LAD)的变化,探索miRNA-328与持续性心房颤动患者心房重构的相关性及螺内酯的干预作用。方法选取2019年1月10日~2020年5月31日沈阳医学院附属第二医院心内科正常体检健康者40例作为对照组,选择住院的持续性房颤患者48例作为持续性房颤组(经常规药物治疗1.5年后),定量检测miRNA-328的相对表达量,通过多普勒超声心动图检测左室射血分数(LVEF)、LAD。对持续性房颤组患者加用螺内酯干预6个月(20 mg, 1次/d),每月进行心电图、肝肾功能、血钾检测。6个月后再次进行多普勒超声心动图、心电图、miRNA-328定量检测。结果持续性房颤组在冠心病、高血压的比例均高于对照组(P<0.05);低密度脂蛋白(LDL-C)及左房内径(LAD)均高于对照组(P<0.01)。与对照组相比,持续性房颤组血清miRNA-328表达水平显著升高(P<0.05),其表达水平与LAD呈正相关(r=0.333, P<0.05),校正后两者仍呈正相关(r=0.449, P<0.05)。服用螺内酯6个月后患者miRNA-328与LAD值均较服药前下降(P<0.05)。结论 miRNA-328可能参与持续性房颤患者的心房重构过程,可成为早期预警与临床诊断的生物学标志物和房颤治疗的新靶点。螺内酯可逆转心房重构,成为预防和治疗持续性房颤的新方法。

AIM To explore the correlation between microRNA-328 and atrial remodeling and the intervention effect of spironolactone by studying the expression of microRNA-328(miRNA-328) and the changes of left atrial diameter(LAD) in patients with persistent atrial fibrillation. METHODS By 2016 European Guidelines for the Management of Atrial Fibrillation, 48 patients with persistent atrial fibrillation after 1.5 years of regular drug treatment from the Department of Cardiology of our hospital were selected as the experimental group and 40 healthy subjects under normal physical examination in the same period were selected as the control group. The relative expression of miRNA-328 was detected by real-time fluorescence quantitative PCR and the left ventricular ejection fraction(LVEF) and left ventricular ejection fraction(LAD) were measured by Doppler echocardiography. The patients with persistent atrial fibrillation in the experimental group were treated with spironolactone for 6 months(20 mg,1 times/day). The electrocardiogram, liver and kidney functions and serum potassium were detected every month to find out whether the liver and kidney functions were abnormal and whether the serum potassium was elevated. Six months later, Doppler echocardiography, electrocardiogram and miRNA-328 quantitative detection were performed again. RESULTS The expression level of serum miRNA-328 in persistent atrial fibrillation group was significantly higher than that in control group.There was a positive correlation between serum miRNA-328 expression and LAD in persistent atrial fibrillation group(r = 0.333, P<0.05). After correction by partial correlation analysis, there was still a positive correlation between them(r = 0.449, P<0.05). After taking spironolactone for 6 months, the values of miRNA-328 and LAD were significantly lower than those before taking spironolactone.CONCLUSION The expression of miRNA-328 in serum of patients with persistent atrial fibrillation suggests that it may participate in the process of atrial remodeling in patients with persistent atrial fibrillation and has diagnostic value. It can be used as a biological marker for early warning and clinical diagnosis of persistent atrial fibrillation and it may also become a new target for the treatment of persistent atrial fibrillation in the future. The decrease of LAD and miRNA-328 expression after the intervention of spironolactone suggests that spironolactone can reverse atrial remodeling, which provides theoretical support for improving the clinical application of atrial remodeling in patients with persistent atrial fibrillation and indicates that spironolactone may become a new method for the prevention and treatment of atrial fibrillation.