微小RNA-196a-2、心房钠尿肽在原发性高血压合并心力衰竭患者血清中表达及其临床意义

Expression and clinical significance of microRNA-196a-2 and atrial natriuretic peptide in patients with essential hypertension and heart failure

目的 探讨微小RNA-196a-2(microRNA-196a-2,miR-196a-2)、心房钠尿肽(atrial natriuretic peptide,ANP)在原发性高血压(essential hypertension,EH)合并心力衰竭(heart failure,HF)患者血清中的表达及其临床意义。方法 选取2019年3月至2020年9月江阴市中医院收治的180例EH患者,根据是否发生HF分为HF组74例和非HF组106例,另选取同期健康体检者90名作为对照组。HF组患者心功能Ⅱ级23例,Ⅲ级29例,Ⅳ级22例。收集研究对象的临床资料及血清标本,采用实时荧光定量聚合酶链反应(polymerase chain reaction,PCR)检测血清miR-196a-2表达水平,采用酶联免疫吸附法检测血清ANP浓度。采用Pearson检验分析血清miR-196a-2、ANP浓度与心功能指标的关系;采用多因素Logistic回归模型分析影响EH患者发生HF的危险因素。结果 非HF组和HF组患者EH分级相比,差异有统计学意义(P<0.05)。血清miR-196a-2表达水平(1.90±0.53>1.57±0.42>1.00±0.00)、ANP浓度[(75.88±19.15)ng/L>(43.46±11.04)ng/L>(28.91±7.29)ng/L]及左心室舒张末期容积(left ventricular end diastolic volume,LVEDV)[(239.77±44.56)mL>(180.36±34.70)mL>(115.42±19.67)mL]、左心室收缩末期容积(left ventricular end systolic volume,LVESV)[(69.86±9.53)mL>(47.14±8.11)mL>(36.95±7.22)mL]由高至低为HF组、非HF组、对照组,左心室射血分数(left ventricular ejection fraction,LVEF)(61.73%±8.24%>52.95%±6.61%>41.38%±5.09%)由高至低为对照组、非HF组、HF组。不同心功能分级EH合并HF患者血清miR-196a-2表达水平、ANP浓度及LVEDV、LVESV由高至低为Ⅳ级、Ⅲ级、Ⅱ级,LVEF由高至低为Ⅱ级、Ⅲ级、Ⅳ级,两两比较差异均有统计学意义(P<0.05)。EH合并HF患者血清miR-196a-2表达水平、ANP浓度分别与LVEF呈负相关,分别与LVEDV、LVESV呈正相关(P<0.05)。EH 3级、LVEF降低及血清miR-196a-2表达水平、ANP浓度升高是影响EH患者发生HF的独立危险因素(P<0.05)。结论EH合并HF患者血清miR-196a-2表达水平、ANP浓度升高,两者均是影响HF发生的危险因素。

Objectives To investigate the expression and clinical significance of microRNA-196a-2(miR-196a-2)and atrial natriuretic peptide(ANP)in patients with essential hypertension(EH)and heart failure(HF). Methods A total of 180 patients with EH admitted to Jiangyin Hospital of Traditional Chinese Medicine from March 2019 to September 2020 were selected and divided into HF group(74 cases)and non HF group(106 cases)according to the occurrence of HF,another 90 healthy people were selected as control group. In HF group,there were 23 cases of gradeⅡ cardiac function,29 cases of grade Ⅲ and 22 cases of grade Ⅳ cardiac function. The clinical data and serum samples were collected. The expression of miR-196a-2 in serum was detected by real-time fluorescent quantitative polymerase chain reaction(PCR). The expression of ANP in serum was detected by enzyme linked immunosorbent assay. Pearson test was used to analyze the relationship between serum expression of miR-196a-2,concentration of ANP and cardiac function. Multivariate Logistic regression model was used to analyze the risk factors of HF in EH patients. Results There was significant difference in EH classification between non HF group and HF group(P<0.05). The expression levels of serum miR-196a-2(1.90±0.53 > 1.57±0.42 > 1.00±0.00)],concentrations of ANP[(75.88±19.15)ng/L >(43.46±11.04)ng/L >(28.91±7.29)ng/L],left ventricular end diastolic volumes(LVEDVs)[(239.77±44.56)mL >(180.36±34.70)mL >(115.42±19.67)mL]and left ventricular end systolic volumes(LVESVs)[(69.86±9.53)mL >(47.14±8.11)mL >(36.95±7.22)mL]from high to low were in HF group,non HF group and control group,and left ventricular ejection fractions(LVEFs)(61.73%±8.24% > 52.95%±6.61% > 41.38%±5.09%)from high to low was in control group,non HF group and HF group. The expression levels of serum miR-196a-2 and concentrations of ANP,LVEDVs and LVESVs from high to low were in EH and HF patients with heart function of grade Ⅳ,grade Ⅲ and grade Ⅱ,and LVEF from high to low were in EH and HF patients with heart function of grade Ⅱ,grade Ⅲ and grade IV,the differences were statistically significant(P<0.05). The expression level of serum miR-196a-2 and concentration of ANP in patients with EH and HF negatively correlated with LVEF,and positively correlated with LVEDV and LVESV(P<0.05). EH grade 3,lower LVEF and higher expression level of miR-196a-2 and higher concentration of ANP were independent risk factors of HF in EH patients(P<0.05). Conclusions The expression level of serum miR-196a-2 and concentration of ANP in patients with EH complicated with HF increase,and both of them are risk factors of HF.