外周血红细胞分布宽度、微小RNA-133a与维持性血液透析患者心力衰竭的关系

Relationship between red blood cell distribution width,miR-133a and heart failure in maintenance hemodialysis patients

目的探讨分析外周血红细胞分布宽度(red cell distribution width,RDW)、微小RNA-133a(micro RNA-133a,miR-133a)与维持性血液透析患者心力衰竭的关系。方法选取2020年12月~2021年12月秦皇岛市第一医院收治的80例维持性血液透析患者,根据有无心力衰竭分为心力衰竭组23例和无心力衰竭组57例,选取50例非透析的终末期肾病患者作为终末期肾病对照组,并选取同期体检无异常的40例健康者作为健康对照组。测量RDW水平,采用实时定量PCR检测外周血miR-133a水平,分析其水平与维持性血液透析患者心力衰竭的关系。结果心力衰竭组外周血RDW水平高于无心力衰竭组、终末期肾病对照组和健康对照组(F=61.144,P<0.001);心力衰竭组血清miR-133a水平低于其余3组(F=73.835,P<0.001)。心力衰竭组心脏每搏量(stroke volume,SV)、左心室射血分数(left ventricular ejection fraction,LVEF)低于无心力衰竭组、终末期肾病对照组、健康对照组(F=120.238、161.756,均P<0.001);心力衰竭组左心室心肌质量指数(left ventricular mass index,LVMI)高于其余3组(F=274.669,P<0.001)。Paerson相关性分析结果显示外周血RDW与SV、LVEF呈负相关关系(r=-0.357、-0.422,P<0.001),与LVMI呈正相关关系(r=0.458,P<0.001);外周血miR-133a与SV、LVEF呈正相关(r=0.412、0.437,均P<0.001),与LVMI呈负相关(r=-0.416,P<0.001)。ROC曲线结果显示:外周血RDW、miR-133a联合检测预测维持性血液透析患者心力衰竭的曲线下面积为0.83,灵敏度和特异度为82.49%、68.37%。结论维持性血液透析患者心力衰竭患者外周血RDW、miR-133a水平与患者心功能密切相关,对预测患者心力衰竭具有较好预测价值。

Objective To explore the relationship between peripheral red blood cell distribution width(RDW),microRNA-133a,and heart failure in maintenance hemodialysis(MHD)patients.Method A total of 80 MHD patients admitted to The First Hospital of Qinhuangdao from December 2020 to December 2021 were recruited and divided into a heart failure group(n=23)and a non-heart failure group(n=57)according to the presence or absence of heart failure.End-stage renal disease(ESRD)patients not on dialysis were recruited as the ESRD control group,and 40 healthy people with normal physical examinations during the same period were recruited as the healthy control group.Their RDW was measured.miR-133a content in peripheral blood was measured by real-time quantitative PCR.The relationship between RDW,miR-133a level and heart failure in MHD patients was then evaluated.Result Peripheral blood RDW was higher in heart failure group than in non-heart failure group(t=11.896,P<0.001),ESRD control group(t=12.010,P<0.001),and healthy control group(t=3.570,P<0.001);the difference between the four groups was statistically significant(F=61.144,P<0.05).Serum miR-133a was lower in heart failure group than in non-heart failure group(t=8.321,P<0.001),ESRD control group(t=8.321,P<0.001),and healthy control group(t=10.395,P<0.001);the difference between the four groups was statistically significant(F=73.835,P<0.05).Stroke volume(SV)and left ventricular ejection fraction(LVEF)were lower in heart failure group than in non-heart failure group(t=12.335,14.044,P<0.001),ESRD control group(t=17.609,17.782,P<0.001),and healthy control group(t=19.195,20.149,P<0.001);the differences between the four groups were statistically significant(F=120.238,161.756,P<0.05).Left ventricular mass index(LVMI)was higher in heart failure group than in non-heart failure group(t=5.46550,P<0.001),ESRD control group(t=17.515,P<0.001),and healthy control group(t=18.124,P<0.001);the difference between the four groups was statistically significant(F=274.669,P<0.05).Pearson correlation analysis showed that peripheral RDW was negatively correlated with SV and LVEF(r=-0.357,-0.422,P<0.001),and positively correlated with LVMI(r=0.458,P<0.001);serum miR-133a was positively correlated with SV and LVEF(r=0.412,0.437,P<0.001),and negatively correlated with LVMI(r=-0.416,P<0.001).ROC curve showed that combined detection of peripheral blood RDW and miR-133a had an area under the curve of 0.83 for predicting heart failure in MHD patients,with a sensitivity and specificity of 82.49%and 68.37%.Conclusion Peripheral RDW and serum miR-133a are closely related to the heart function in MHD patients,and have a better value for predicting heart failure in MHD patients.