慢性心力衰竭合并心房颤动患者血清miR-126、miR-222与心功能和主要不良心血管事件的关系

The relationship between serum miR-126,miR-222,cardiac function,and major adverse cardiovascular events in patients with chronic heart failure complicated with atrial fibrillation

目的分析慢性心力衰竭(CHF)合并心房颤动(AF)患者血清微小核糖核酸(miR)-126、miR-222与心功能和主要不良心血管事件(MACE)的关系。方法选取2020年1月—2022年10月徐州医科大学附属连云港医院心内科收治的CHF合并AF患者120例为AF组,根据纽约心脏病协会(NYHA)心功能分级分为Ⅰ级22例、Ⅱ级29例、Ⅲ级26例、Ⅳ级43例。随访3个月,根据是否发生MACE分为MACE亚组和非MACE亚组;选取同期收治的未合并AF的CHF患者100例为非AF组。另选取同期医院体检健康志愿者80例为健康对照组。检测并比较3组及不同NYHA心功能分级CHF合并AF患者血清miR-126、miR-222水平;分析CHF合并AF患者血清miR-126、miR-222水平与NYHA心功能分级的相关性;多因素Logistic回归分析CHF合并AF患者发生MACE的影响因素。受试者工作特征(ROC)曲线分析血清miR-126、miR-222水平对CHF合并AF患者发生MACE的预测价值。结果血清miR-126、miR-222水平AF组<非AF组<健康对照组(F/P=277.894/<0.001、410.653/<0.001);血清miR-126、miR-222水平Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级依次降低(F/P=147.517/<0.001、115.625/<0.001);CHF合并AF患者血清miR-126、miR-222水平与NYHA心功能分级呈负相关(r_(s)=-0.501、-0.496,P均<0.001)。随访3个月,CHF合并AF患者120例MACE发生率为31.67%(38/120),NYHA心功能分级Ⅲ~Ⅳ级和N末端前体B型钠尿肽升高为CHF合并AF患者MACE的独立危险因素[OR(95%CI)=1.872(1.381~2.538)、1.002(1.000~1.004)],血清miR-126升高、miR-222升高为独立保护因素[OR(95%CI)=0.679(0.535~0.862)、0.531(0.379~0.743)];血清miR-126、miR-222及二者联合预测CHF合并AF患者发生MACE的AUC分别为0.734、0.741、0.839,二者联合优于各自单独预测效能(Z=4.235,4.136,P=0.013,0.014)。结论CHF合并AF患者的血清miR-126、miR-222水平降低,与心功能降低和MACE发生有关,血清miR-126、miR-222水平联合检测对CHF合并AF患者MACE具有较高的预测效能。

Objective To analyze the relationship between serum miR-126,miR-222,cardiac function,and major adverse cardiovascular events(MACE)in patients with chronic heart failure(CHF)and atrial fibrillation(AF).Methods 120 patients with CHF combined with AF admitted to the Cardiology Department of Lianyungang Hospital Affiliated to Xuzhou Medical University from January 2020 to October 2022 were selected as the AF group.According to the New York Heart Association(NYHA)cardiac function classification,they were divided into Grade I 22 cases,Grade II 29 cases,Grade III 26 cases,and Grade IV 43 cases.Follow up for 3 months and divide into MACE subgroup and non-MACE subgroup based on the occurrence of MACE.100 CHF patients without concomitant AF admitted during the same period were selected as the non-AF group.Another 80 healthy volunteers who underwent physical examinations in hospitals during the same period were selected as the healthy control group.Detect and compare the serum levels of miR-126 and miR-222 in three groups of CHF patients with AF and different NYHA heart function grades.Analyze the correlation between serum miR-126,miR-222 levels and NYHA cardiac function grading in patients with CHF combined with AF.Multivariate logistic regression analysis on the influencing factors of MACE in patients with CHF and AF.The predictive value of receiver operating characteristic(ROC)curve analysis of serum miR-126 and miR-222 levels for MACE in patients with CHF and AF.Results The levels of serum miR-126 and miR-222 in the AF group<non AF group<healthy control group(F/P=277.894/<0.001,410.653/<0.001).The levels of serum miR-126 and miR-222 in grades I,II,III,and IV decreased sequentially(F/P=147.517/<0.001,115.625/<0.001).The serum levels of miR-126 and miR-222 in patients with CHF combined with AF were negatively correlated with NYHA cardiac function grading(r_(s)=-0.501 and-0.496,P<0.001).During a 3-month follow-up,the incidence of MACE in 120 patients with CHF and AF was 31.67%(38/120).NYHA heart function grades III-IV and elevated N-terminal precursor B-type natriuretic peptide were independent risk factors for MACE in CHF and AF patients[OR(95%CI)=1.872(1.381-2.538),1.002(1.000-1.004)].Elevated serum miR-126 and miR-222 were independent protective factors[OR(95%CI)=0.679(0.535-0.862),0.531(0.379-0.743)].The AUC of serum miR-126,miR-222,and their combination in predicting MACE in CHF patients with AF were 0.734,0.741,and 0.839,respectively.The combination of the two was superior to their individual predictive efficacy(Z=4.235,4.136,P=0.013,0.014).Conclusion The decrease in serum miR-126 and miR-222 levels in patients with CHF combined with AF is related to decreased heart function and the occurrence of MACE.The combined detection of serum miR-126 and miR-222 levels has a high predictive power for MACE in patients with CHF combined with AF.