慢性心力衰竭患者血浆循环微小RNA-19b的表达情况分析

Analysis of the expression of plasma circulating microRNA-19b in patients with chronic heart failure

目的探讨慢性心力衰竭(简称心衰)患者血浆循环微小RNA(mirco RNA,miR)-19b与N末端B型利钠肽前体(N-terminal pro-B type natriuretic peptide,NT-proBNP)及心功能的相关性,评价循环miR-19b对慢性心衰的诊断及评估价值。方法选择首都医科大学附属北京朝阳医院2016年10月至2018年11月收住院的心衰患者208例作为心衰组,根据左心室射血分数(left ventricular ejection fraction,LVEF)及舒张早期快速充盈波和舒张晚期心房收缩波充盈速度比(E/A)将心衰组患者分为收缩性心衰组(LVEF<45%)及舒张性心衰组(LVEF≥45%),根据年龄将心衰组分为≥60岁组与<60岁组。选取同期住院的年龄及性别匹配的非心衰冠心病及高血压患者80例作为对照组。记录所有患者的年龄、性别、病史、实验室检查及用药情况等临床资料。所有患者于入院次日晨起空腹取血,使用反转录聚合酶链反应检测血浆中循环mi R-19b的表达水平并进行组间比较,采用多因素logistic回归分析心衰患者血浆循环mi R-19b水平与NT-pro BNP及心功能的相关性。结果心衰组的循环mi R-19b表达水平为1.039±0.348,明显低于对照组(1.341±0.381),差异有显著性(P<0.05);收缩性心衰组循环mi R-19b表达水平(1.005±0.377)与舒张性心衰组(1.055±0.340)比较差异无显著性(P=0.335)。多因素logistic回归分析显示,纠正心衰发生其他相关因素后,mi R-19b仍与心衰呈负相关。受试者工作特征曲线分析显示,循环mi R-19b诊断心衰的曲线下面积(area under curve,AUC)为0.739±0.035(P<0.05),NT-pro BNP诊断心衰的AUC为0.896±0.024(P<0.05),NT-pro BNP与mi RNA-19b比值诊断心衰的AUC为0.902±0.023(P<0.05)。结论心衰患者血浆循环mi R-19b的表达水平降低,且不受心脏收缩功能、舒张功能及年龄的影响,对心衰具有辅助诊断价值。

Objective Investigate the correlation of circulating mircoRNA-19b with NT-proBNP and cardiac function in chronic heart failure(CHF)patients and evaluate the value of circulating miR-19b in the diagnosis and assessment of CHF.Method The CHF inpatients and non-CHF inpatients matched in age and gender in Beijing Chaoyang Hospital from October 2016 to December 2018 were recruited.The clinical characteristics and treatments were recorded.Fasting blood was collected on the second day after admission for the detection of circulating miR-19b by qRT-PCR.The miR-19b were compared between two groups,and the correlations of miR-19b with plasma NTproBNP and cardiac function was determined,aiming to evaluate the value of circulating miR-19b in the diagnosis and assessment of CHF.Result The miR-19b expression in the CHF group was significantly lower than in the control group(1.039±0.348 vs 1.341±0.381,P<0.05),but it was comparable between systolic heart failure patients and diastolic heart failure patients(1.005±0.377 vs1.055±0.340,P=0.335).Multivariate logistic regression analysis showed,after adjustment for other factors related to CHF,miR-19b expression was still negatively associated with CHF.The area under the receiver operating characteristic curve(AUC)of miR-19b,NT-proBNP and NT-proBNP/miRNA-19b in the diagnosis of CHF was 0.739±0.035(P<0.05),0.896±0.024(P<0.05)and 0.902±0.023(P<0.05),respectively.Conclusion The circulating miR-19b expression reduces in patients with CHF,which is not affected by systolic and diastolic functions and has no relationship with age.Circulating miR-19b is helpful for the diagnosis of CHF.