长链非编码RNA MYCNOS预测脓毒症合并急性心力衰竭患者发生主要不良心血管事件的价值研究

Predictive value of lncRNA MYCNOS for major adverse cardiovascular events in patients with sepsis and acute heart failure

目的探究长链非编码RNA MYCNOS(lncRNA MYCNOS)对脓毒症合并急性心力衰竭患者发生主要不良心血管事件(major adverse cardiovascular events,MACE)的预测价值。方法选取鄂东医疗集团黄石市中心医院2019年3月至2022年1月177例确诊为脓毒症合并急性心力衰竭的患者,其中男125例,女52例,年龄(61.77±6.14)岁。所有患者随访截止时间为2022年2月1日,根据随访是否发生MACE将患者分为MACE组和非MACE组。比较两组患者外周血中的lncRNA MYCNOS相对表达水平及其他一般临床资料,通过Cox回归分析脓毒症合并急性心力衰竭患者发生MACE的危险因素,Pearson相关性分析lncRNA MYCNOS与各危险因素的相关性。绘制受试者工作特征曲线(receiver operating characteristic curve,ROC),用ROC评估lncRNA MYCNOS对脓毒症合并急性心力衰竭患者发生MACE的预测价值。计量资料采用独立样本t检验或秩和检验,计数资料采用χ^(2)检验。结果32例患者随访期间发生MACE。MACE患者慢性心功能不全占比、左心室射血分数(LVEF)低于非MACE患者(均P<0.05),外周血C反应蛋白(CRP)值、N末端B型脑钠肽前体(NTproBNP)、中性粒细胞/淋巴细胞比值(NLR)、机械通气时间、住ICU时间、住院时间和外周血中lncRNA MYCNOS相对水平高于非MACE患者(均P<0.05)。多因素Cox回归分析显示,NLR(HR=1.360,95%CI:1.026~1.791,P=0.032)和lncRNA MYCNOS(HR=5.32,95%CI:1.421~19.930,P=0.013)为脓毒症合并急性心力衰竭患者发生MACE的影响因素。相关性分析结果显示,lncRNA MYCNOS与NLR呈正相关性(r=0.412,P<0.001)。ROC表明,lncRNA MYCNOS诊断脓毒症合并急性心力衰竭患者发生MACE的切点为1.829,曲线下面积(AUC)为0.976(95%CI:0.951~1.000)。结论lncRNA MYCNOS为脓毒症合并急性心力衰竭患者发生MACE的独立预测因子。

Objective To investigate the predictive value of long non-coding RNA MYCNOS(lncRNA MYCNOS)for major adverse cardiovascular events(MACE)in patients with sepsis and acute heart failure.Methods One hundred and seventy-seven patients diagnosed with sepsis combined with acute heart failure in Huangshi Central Hospital,Edong Healthcare Group from March 2019 to January 2022 were selected,including 125 males and 52 females,aged(61.77±6.14)years,and all patients were followed up until February 1,2022.The patients were divided into a MACE group and a non-MACE group according to whether MACE occurred during the follow-up.The relative expression level of lncRNA MYCNOS in the peripheral blood and other general clinical information were compared between the two groups,the risk factors for the occurrence of MACE in the patients with sepsis and acute heart failure were analyzed by Cox regression analysis,the correlations between lncRNA MYCNOS and risk factors were analyzed by Pearson correlation analysis,and the predictive value of lncRNA MYCNOS for MACE in the patients with sepsis and acute heart failure was evaluated by the receiver operating characteristic curve(ROC).Independent sample t test or rank sum test was used for the measurement data,and chi-square test was used for the count data.Results MACE occurred during the follow-up in 32 patients.The proportion of chronic cardiac insufficiency and left ventricular ejection fraction(LVEF)of the MACE patients were lower than those of the non-MACE patients(both P<0.05),and the peripheral blood C-reactive protein(CRP)value,N-terminal pro-B-type brain natriuretic peptide(NTproBNP),ratio of neutrophil/lymphocyte(NLR),mechanical ventilation time,length of ICU stay,length of hospital stay,and relative level of lncRNA MYCNOS in the peripheral blood were higher than those of the non-MACE patients(all P<0.05).Multivariate Cox regression analysis showed that NLR(HR=1.360,95%CI:1.026-1.791,P=0.032)and lncRNA MYCNOS(HR=5.32,95%CI:1.421-19.930,P=0.013)were the influencing factors of MACE in patients with sepsis and acute heart failure.Correlation analysis showed that lncRNA MYCNOS was positively correlated with NLR(r=0.412,P<0.001).The ROC showed that the cut-off point of lncRNA MYCNOS in the diagnosis of MACE in patients with sepsis and acute heart failure was 1.829,and the area under the curve(AUC)was 0.976(95%CI:0.951-1.000).Conclusion LncRNA MYCNOS is an independent predictor of the development of MACE in sepsis combined with acute heart failure.