miRNA-19b在老年慢性阻塞性肺疾病急性加重相关肺动脉高压患者血浆中的变化及其临床价值

The changes and clinical value of plasma miRNA-19b in elderly patients with pulmonary hypertension related to acute exacerbation of chronic obstructive pulmonary disease

目的探讨血浆miRNA⁃19b在慢性阻塞性肺疾病急性加重期(AECOPD)相关肺动脉高压(PH)老年患者中的临床价值。方法选择2020年11月—2021年11月在上海市浦东新区浦南医院呼吸科病房住院的AECOPD老年患者为研究对象,根据心超测定的肺动脉收缩压(PASP)结果,将研究对象分为AECOPD组(A组)、AECOPD合并PH组(B组);再根据肺动脉收缩压(PASP)结果将B组分为轻度肺动脉高压组(B1组)、中度肺动脉高压组(B2组)、重度肺动脉高压组(B3组)共3个亚组。测定各组患者入院时的血浆miRNA⁃19b、PASP、血浆IL⁃6、血浆CPR、血浆NT⁃ProBNP水平;评估各组动脉血气、6分钟步行距离;比较和统计学分析上述指标值。结果血浆miRNA⁃19b、血浆IL⁃6、血浆CRP、血浆NT⁃ProBNP水平,以及PASP值,pH值,PaO2值,PaCO_(2)值、6分钟步行距离于A、B组两两比较以及B1、B2、B3组两两比较,差异均有统计学意义(P<0.05)。A、B组以及B1、B2、B3组患者,血浆miRNA⁃19b水平与PASP值、血浆IL⁃6水平、血浆CRP水平、血浆NT⁃ProBNP水平、PaCO_(2)值均呈负相关性,与pH值、PaO2值、6分钟步行距离均呈正相关性。结论合并肺动脉高压的老年AECOPD患者血浆miRNA⁃19b水平明显低于不合并肺动脉高压的AECOPD老年患者;在AECOPD相关PH老年患者中,随着肺动脉压力逐渐增高,血浆miRNA⁃19b水平逐渐降低。

Objective To investigate the clinical value of plasma miRNA⁃19b in elderly patients with pulmonary hyper⁃tension(PH)related to acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods Elderly patients with AECOPD hospitalized in wards of Department of Respiratory Disease,Punan Hospital,Pudong New District from Novem⁃ber 2020 to November 2021 were selected as the research subjects.According to the results of pulmonary artery systolic pressure(PASP)measured by echocardiography,they were divided into AECOPD group(group A)and AECOPD combined with PH group(group B).Then according to the results of PASP,the patients in the group B were divided into three subgroups:mild PH group(group B1),moderate PH group(group B2),and severe PH group(group B3).The levels of plasma miRNA⁃19b,PASP,IL⁃6,CPR and NT⁃ProBNP of all groups were measured at admission,and arterial blood gas and 6⁃minute walk⁃ing distance of all groups were assessed.The above index values were compared and statistically analyzed among all groups.Results There were significantly statistical differences in the plasma levels of miRNA⁃19b,IL⁃6,CRP and NT⁃ProBNP,as well as the values of PASP,pH,PaO2,PaCO_(2) and 6⁃minute walking distance between the group A and group B and among the group B1,group B2,and group B3(P<0.05).In group A and group B,as well as group B1,group B2 and group B3,the plasma level of miRNA⁃19b was negatively correlated with PASP,IL⁃6 level,CRP level,NT⁃ProBNP level and PaCO_(2),and was positively correlated with pH,PaO2 and 6⁃minute walking distance.Conclusion The level of plasma miRNA⁃19b of eld⁃erly AECOPD patients with PH is significantly lower than that of elderly AECOPD patients without PH.In the elderly patients with AECOPD⁃related PH,the level of plasma miRNA⁃19b gradually decreases with the increase of pulmonary artery pressure.