miR-26a-5p在急性心力衰竭患者血浆中的表达及其与短期预后的关系

The Expression of MiR-26a-5p in Plasma of Patients with Acute Heart Failure and Its Relationship with Short-Term Prognosis

目的探讨微小RNA-26a-5p(microRNA-26a-5p,miR-26a-5p)在急性心力衰竭(AHF)患者血浆中的表达及其与短期预后的关系。方法选取2019年1月至2020年4月期间在我院接受治疗的AHF患者148例作为AHF组,根据患者90 d后的预后情况将其分为预后不良组和预后良好组。另选取50例在我院进行体检的健康志愿者作为对照组。收集AHF患者的年龄、性别、体质量指数、入院心率、舒张压、收缩压、血肌酐、超声心动图检查指标[左室舒张末期内径(LVEDD)、左室射血分数(LVEF)]等,检测所有研究对象的miR-26a-5p、N末端B型利钠肽原(N-terminal pro-brain natriuretic peptide,NT-proBNP)。结果AHF组的血浆中的miR-26a-5p相对表达量低于对照组,NT-proBNP水平高于对照组(P<0.05);预后不良组的年龄、入院心率、LVEDD、NT-proBNP均高于预后良好组,miR-26a-5p相对表达量、体质量指数、收缩压、LVEF均低于预后良好组(P<0.05);Logistic回归分析结果显示,年龄、入院心率、NT-proBNP均是AHF患者预后不良的独立危险因素(P<0.05),而miR-26a-5p则是AHF患者短期预后不良的保护因素(P<0.05);miR-26a-5p、NT-proBNP对AHF患者预后均有一定的预测价值,miR-26a-5p的曲线下面积为0.751(95%CI:0.665~0.837),灵敏度为57.10%,特异性为80.20%,约登指数为0.373,NT-proBNP的曲线下面积为0.790(95%CI:0.712~0.869),灵敏度为76.20%,特异性为67.00%,约登指数为0.432。二者联合检测时的灵敏度为83.33%,特异性为78.30%,约登指数为0.616,预测价值有了明显的提升。结论miR-26a-5p在AHF患者血浆中异常低表达,且其表达水平与短期预后密切相关,其联合NT-proBNP对AHF患者短期预后有较高的预测价值。

Objective To investigate the expression of microRNA-26a-5p(miR-26a-5p)in plasma of patients with acute heart failure(AHF)and its relationship with short-term prognosis.Methods A total of 148 AHF patients who were treated in our hospital from January,2019 to April,2020 were selected as the AHF group.According to the prognosis of the patients after 90 days,they were divided into a poor prognosis group and a good prognosis group.Another 50 healthy volunteers who underwent physical examination in our hospital were selected as the control group.Age,sex,body mass index,admission heart rate,diastolic blood pressure,systolic blood pressure,serum creatinine,echocardiographic parameters[left ventricular end-diastolic diameter(LVEDD),and left ventricular ejection fraction(LVEF)]of patients with AHF were collected,and levels of miR-26a-5p and N-terminal pro-brain natriuretic peptide(NT-proBNP)of all subjects were detected.Results The relative expression of miR-26a-5p in plasma of the AHF group was lower than that of the control group,while the level of NT-proBNP was higher than that of the control group(P<0.05);Age,admission heart rate,LVEDD,NT-proBNP in the poor prognosis group were higher than those in the good prognosis group,while miR-26a-5p,body mass index,systolic blood pressure,and LVEF were lower than those in good prognosis group(P<0.05).Logistic regression analysis showed that age,admission heart rate and NT proBNP were independent risk factors for the poor prognosis of AHF patients(P<0.05),while miR-26a-5p was a protective factor for the poor short-term prognosis of AHF patients(P<0.05);miR-26a-5p and NT-proBNP had certain predictive value for the prognosis of patients with AHF.Area under the curve of miR-26a-5p was 0.751(95%CI:0.665-0.837),with sensitivity of 57.10%,specificity of 80.20%,and Yoden index was 0.373.Area under the curve of NT-proBNP was 0.790(95%CI:0.712-0.869),with sensitivity of 76.20%,specificity of 67.00%,and Yoden index was 0.432.The sensitivity,specificity and Yoden index of the joint-index methods were 83.33%,78.30%and 0.616 respectively,with an improved predictive value.Conclusion The expression of miR-26a-5p is abnormally low in the plasma of AHF patients,and its expression level is closely related to the short-term prognosis.Its combination with NT-proBNP has a high predictive value for the short-term prognosis of AHF patients.