循环微RNA-134在原发性高血压合并慢性心力衰竭病人体内表达及临床应用

Expression and clinical application of circulating microRNA-134 in patients with essential hypertension complicated with chronic heart failure

目的探讨循环微RNA-134(miR-134)在原发性高血压合并慢性心力衰竭病人体内表达情况及临床应用价值。方法选择长沙市第一医院2021年1月至2022年3月收治的200例原发性高血压合并慢性心力衰竭病人(合并组),另选取同期在该院诊治和体检的单纯原发性高血压病人(高血压组)、单纯慢性心力衰竭病人(心衰组)及健康人群(对照组)各200例。采用实时荧光定量PCR(RT-qPCR)检测各组受试者循环miR-134表达情况并对比。比较合并组不同美国纽约心脏病学会(NYHA)心功能分级病人间循环miR-134表达差异。采用Pearson相关性分析合并组病人循环miR-134表达与其临床指标及实验室指标的相关性。采用logistic回归分析循环miR-134表达与原发性高血压病人并发慢性心力衰竭的关系,并绘制受试者操作特征(ROC)曲线分析循环miR-134表达对原发性高血压合并慢性心力衰竭病人的诊断价值。结果高血压组、心衰组、合并组循环miR-134表达水平均高于对照组(0.83±0.16、0.85±0.16、0.92±0.16比0.43±0.08,均P<0.001),合并组高于高血压组、心衰组(P<0.05);合并组和心衰组中NYHA心功能分级Ⅲ、Ⅳ级病人循环miR-134表达水平均高于Ⅱ级(0.94±0.17、1.04±0.19比0.87±0.16;0.88±0.17、0.98±0.16比0.79±0.15,均P<0.001),Ⅳ级高于Ⅲ级(P<0.05);合并组中并发糖尿病病人的循环miR-134表达高于未并发糖尿病病人(P<0.05);Pearson相关性分析结果显示,合并组病人循环miR-134表达水平与N末端B型利钠肽原(NT-proBNP)、C反应蛋白(CRP)、磷酸肌酸激酶同工酶(CK-MB)、肌钙蛋白I(cTnI)水平均呈正相关(P<0.05);多因素logistic回归分析结果显示循环miR-134表达、NT-proBNP、CRP、CK-MB、cTnI水平和糖尿病均是原发性高血压病人并发慢性心力衰竭的危险因素(P<0.05);ROC曲线分析结果显示循环miR-134表达水平诊断原发性高血压合并慢性心力衰竭的截断值、灵敏度、特异度、曲线下面积(AUC)分别为0.91、87.50%、76.50%、0.79[95%CI:(0.75,0.83)],诊断原发性高血压、慢性心力衰竭的截断值、灵敏度、特异度、AUC分别为0.59、82.00%、73.00%、0.78[95%CI:(0.74,0.82)];0.61、85.00%、75.00%、0.79[95%CI:(0.74,0.83)]。结论原发性高血压合并慢性心力衰竭病人循环miR-134表达水平偏高,且该指标是原发性高血压病人并发慢性心力衰竭的危险因素,并对原发性高血压合并慢性心力衰竭病人具有一定的诊断价值。

Objective To investigate the expression and clinical application value of circulating microRNA-134(miR-134)in patients with essential hypertension complicated with chronic heart failure.Methods A total of 200 patients with essential hypertension complicated with chronic heart failure(combined group)treated in the First Hospital of Changsha from January 2021 to March 2022 were selected.In addition,200 patients with simple essential hypertension(hypertension group),200 patients with simple chronic heart failure(heart failure group)and 200 healthy people(control group)were selected for diagnosis and physical examination in this hospital at the same time.The expression of circulating miR-134 in each group were detected and compared by real-time fluorescence quantitative PCR(RT-qPCR).The expression of circulating miR-134 in patients with different cardiac function grades of New York Heart Association(NYHA)in the combined group was compared.Pearson's correlation was used to analyze the correlation between the expression of circulating miR-134 and its clinical and laboratory indexes in the combined group.Logistic regression was used to analyze the relationship between the expression of circulating miR-134 and patients with essential hypertension complicated with chronic heart failure,and the receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic value of circulating miR-134 expression in patients with essential hypertension complicated with chronic heart failure.Results The expression levels of circulating miR-134 in hypertension group,heart failure group and combined group were higher than that in the control group(0.83±0.16,0.85±0.16,0.92±0.16 vs.0.43±0.08,all P<0.001),which in combined group was higher than that in hypertension group and heart failure group(P<0.05).The expression levels of circulating miR-134 in patients with NYHA cardiac function gradeⅢandⅣin the combined group and heart failure group were higher than that in gradeⅡ(0.94±0.17,1.04±0.19 vs.0.87±0.16;0.88±0.17,0.98±0.16 vs.0.79±0.15,all P<0.001),which in gradeⅣwas higher than that in gradeⅢ(P<0.05).The expression of circulating miR-134 in patients with diabetes complicated with diabetes mellitus was higher than that in patients without diabetes mellitus(P<0.05).Pearson's correlation analysis showed that the expression levels of circulating miR-134 in the combined group was positively correlated with the levels of N terminal B type natriuretic peptide(NT-proBNP),C reactive protein(CRP),creatine kinase isoenzyme(CK-MB)and troponin I(cTnI)(P<0.05).Multivariate Logistic regression analysis showed that circulating miR-134 expression,NT-proBNP,CRP,CK-MB,cTnI levels and diabetes were risk factors for chronic heart failure in patients with essential hypertension(P<0.05).ROC curve analysis showed that the cut-off value,sensitivity,specificity and area under the curve of circulating mir-134 expression level in the diagnosis of essential hypertension complicated with chronic heart failure respectively were 0.91,87.50%,76.50%and 0.79[95%CI:(0.75,0.83)],and the cut-off value,sensitivity,specificity and area under the curve in the diagnosis of essential hypertension respectively were 0.59,82.00%,73.00%and 0.78[95%CI:(0.74,0.82)],and the cut off value,sensitivity,specificity and area under the curve for the diagnosis of chronic heart failure respectively were 0.61,85.00%,75.00%and 0.79[95%CI:(0.74,0.83)].Conclusion The expression level of circulating miR-134 in patients with essential hypertension complicated with chronic heart failure is high,and this index is a risk factor for patients with essential hypertension complicated with chronic heart failure,which has certain diagnostic value for patients with essential hypertension complicated with chronic heart failure.