血清微小RNA-30d水平与慢性心力衰竭患者心功能的相关性及其在预后评估中的价值

Association between micro RNA-30d and adverse cardiovascular events in patients with chronic heart failure

目的探讨血清微小RNA-30d水平与慢性心力衰竭(chronic heart failure,CHF)患者短期内发生预后不良事件的相关性分析。方法纳入自2019年11月—2021年2月于同济大学附属同济医院门诊就诊并确诊CHF的56例患者作为CHF组,另选门诊体检健康者50例作为对照组。所有受试者均进行病史采集、体格检查、血生化指标检测,并采用qPCR检测血清miRNA-30d表达水平。对CHF患者随访12个月,记录所发生的预后不良事件,按照有无心血管事件分为事件组和无事件组,并进行统计学分析。结果CHF组患者中血清miR-30d的表达水平显著低于对照组[(0.60±0.26)vs(1.052±0.40),P<0.05],其中CHF事件组的血清miR-30d的表达水平明显低于CHF无事件组(P<0.05)。二元逻辑回归分析结果显示,血清miR-30d(OR=0.010,95%CI:0.000~0.286,P=0.007)可以作为CHF患者发生预后不良事件的独立影响因素。通过绘制ROC曲线,微小RNA-30d制作的模型能够有效的筛选CHF患者中的高危患者,曲线下面积(AUC)为0.793,而联合心超参数,即左室射血分数、左室舒张末期内径、左房内径以及微小RNA的AUC为0.848。提示微小RNA-30d能够在CHF患者中预测患者预后不良事件的发生,微小RNA-30d的表达水平越低,心血管事件发生率越高,而结合左室射血分数、左室舒张末期内径、左房内径等心功能参数具有更高的预后评估价值。结论血清miRNA-30d水平能够较好的评估CHF患者短期预后,与心功能指标联合有更好的预测效果。

Objective To investigate the association between serum micro RNA-30d levels and adverse cardiovascular events in patients with chronic heart failure(CHF).Methods Fifty-six patients with chronic heart failure who visited outpatient clinic of Tongji Hospital from November 2019 to February 2021(CHF group)and 50 healthy subjects who received health check up(control group)were enrolled in the study.The clinical data and laboratory tests were collected and the expression of micro RNA-30d in serum was detected by real-time quantitative fluorescent PCR(qRT-PCR).Patients with CHF were followed up for 12 months and adverse events were documented.Results Serum micro RNA-30d levels in CHF patients were significantly lower than those in the control group[(0.60±0.26)vs(1.052±0.40),P<0.05].Serum micro RNA-30d levels in CHF patients with adverse events were significantly lower than those without adverse events(P<0.05).Binary Logistic regression analysis showed that serum miR-30d(OR=0.010,95%CI:0.0000.286,P=0.007)was an independent influencing factor of cardiovascular events in CHF patients.The area under ROC curve(AUC)of micro RNA-30d in predicting cardiovascular events in CHF patients was 0.793.The prognostic model combined with echocardiography parameters(left ventricular ejection fraction,left ventricular end-diastolic diameter,left atrial diameter and others)had a AUC of 0.848.Conclusion Serum microRNA-30d levels can help to predict short-term prognosis in patients with chronic heart failure.