老年慢性心力衰竭患者血清microRNA-208a、CASP3与心室重构和预后的关系

Association of serum microRNA-208a and CASP3 levels with ventricular remodeling and prognosis in elderly patients with chronic heart failure

目的探讨老年慢性心力衰竭(CHF)患者血清microRNA-208a(miR-208a)、含半胱氨酸的天冬氨酸蛋白水解酶3(CASP3)与心室重构和预后的关系。方法选取2019年1月—2021年9月新余市中医院收治的155例老年CHF患者为CHF组,另选取同期该院体检健康者57例为对照组,CHF组患者根据预后情况分为预后不良组(58例)和预后良好组(97例)。实时荧光定量聚合酶链反应(qRT-PCR)检测miR-208a mRNA相对表达量;酶联免疫吸附试验(ELISA)检测CASP3、B型脑利钠肽(BNP)水平;采用Pearson/Spearman相关系数分析老年CHF患者血清miR-208a、CASP3与BNP、右心室内径(RVD)、左心室舒张末期内径(LVEDD)、左心室短轴缩短率(LVFS)、左室射血分数(LVEF)、左心室质量指数(LVMI)的相关性;多因素Logistic回归分析老年CHF患者预后不良的影响因素;绘制受试者工作特征(ROC)曲线分析血清miR-208a、CASP3对老年CHF患者预后不良的预测价值。结果CHF组血清miR-208a、CASP3、BNP水平,LVMI高于对照组,RVD、LVEDD大于对照组,LVFS、LVEF低于对照组(P<0.05)。Pearson/Spearman相关性分析结果显示,老年CHF患者血清miR-208a、CASP3与BNP、RVD、LVEDD、LVMI呈正相关(r/rs=0.577、0.627、0.535、0.619和0.619、0.721、0.601、0.631,均P<0.05),与LVFS、LVEF呈负相关(r/rs=-0.555、-0.568和-0.655、-0.700,均P<0.05),血清miR-208a与CASP3呈正相关(rs=0.638,P<0.05)。多因素Logistic回归分析结果显示,NYHA≥Ⅲ级[OR=3.383(95%CI:1.358,8.423)]、BNP[OR=1.006(95%CI:1.002,1.009)]、LVMI[OR=1.114(95%CI:1.005,1.233)]、miR-208a[OR=1.203(95%CI:1.096,1.321)]、CASP3[OR=1.196(95%CI:1.088,1.315)]为老年CHF患者预后不良的独立危险因素(P<0.05),LVEF[OR=0.867(95%CI:0.753,0.998)]为独立保护因素(P<0.05)。ROC曲线分析结果显示,血清miR-208a、CASP3单独及联合预测老年CHF患者预后不良的ROC曲线下面积(AUC)分别为0.785、0.783和0.867。结论血清miR-208a、CASP3与老年CHF患者心室重构和预后密切相关,可能成为老年CHF患者预后不良的辅助预测指标。

Objective To investigate the relationship of serum microRNA-208a(miR-208a)and cysteinyl aspartate specific proteinase 3(CASP3)levels with ventricular remodeling and prognosis in elderly patients with chronic heart failure(CHF).Methods A total of 155 elderly patients with CHF admitted from January 2019 to September 2021 in Xinyu Traditional Chinese Medicine Hospital(CHF group)were selected and divided into a poor prognosis subgroup(n=58)and a good prognosis subgroup(n=97)according to their prognosis,and another 57 healthy patients(control group)were selected from the hospital physical examination during the same period.The miR-208a level was measured by qPCR and the CASP3 level was measured by ELISA.The correlation between serum miR-208a and CASP3 levels and B-type brain natriuretic peptide(BNP),right ventricular diameter(RVD),left ventricular end diastolic diameter(LVEDD),left ventricular fractional shortening(LVFS),left ventricular ejection fraction(LVEF),and left ventricular mass index(LVMI)in elderly patients with CHF was analyzed using Pearson/Spearman correlation coefficients,multi-factor logistic regression was used to analyze the factors influencing poor prognosis in elderly CHF patients,and ROC curves were used to analyze the predictive value of serum miR-208a and CASP3 levels on poor prognosis in elderly CHF patients.Results Serum levels of miR-208a,CASP3,and BNP,and RVD,LVEDD and LVMI were higher in the CHF group than in the control group,and LVFS and LVEF were lower than in the control group(P<0.05).Pearson/Spearman correlation coefficients showed that serum miR-208a and CASP3 levels in elderly CHF patients were positively correlated with BNP,RVD,LVEDD,and LVMI(r/rs=0.577,0.627,0.535,0.619,0.619,0.721,0.601 and 0.631,all P<0.05)and negatively correlated with LVFS and LVEF(r/rs=-0.555,-0.568,-0.655 and-0.700,all P<0.05);serum miR-208a was positively correlated with CASP3 levels(rs=0.638,P<0.05).Multifactorial logistic regression analysis showed that NYHA classification≥gradeⅢ[OR=3.383(95%CI:1.358,8.423)]and BNP[OR=1.006(95%CI:1.002,1.009)],LVMI[OR=1.114(95%CI:1.005,1.233)],miR-208a[OR=1.203(95%CI:1.096,1.321)],and CASP3[OR=1.196(95%CI:1.088,1.315)]were independent risk factors for poor prognosis in elderly CHF patients,and elevated LVEF[OR=0.867(95%CI:0.753,0.998)]was an independent protective factor(all P<0.05).ROC curve analysis showed that the area under the curve for serum miR-208a and CASP3 levels alone and in combination to predict poor prognosis in elderly CHF patients was 0.785,0.783 and 0.867,respectively.Conclusion Elevated levels of serum miR-208a and CASP3 are closely associated with ventricular remodeling and poor prognosis in elderly CHF patients,and may be an auxiliary predictor of poor prognosis in elderly CHF patients.