心脏彩超联合miR-29b对冠心病合并左心室肥厚的诊断价值分析

Diagnostic value of cardiac ultrasound combined with miR-29b for coronary heart disease complicated by left ventricular hypertrophy

目的探讨心脏彩超联合微小RNA(miR)-29b对冠心病合并左心室肥厚(left ventricular hypertrophy,LVH)的诊断价值。方法选取2018年9月~2023年11月医院收治的68例冠心病合并LVH患者为LVH组,同期选取单纯冠心病(不合并LVH)患者136例为非LVH组。两组均行心脏彩超检查,测定相关指标:左室后壁厚度、室间隔厚度、左心室舒张末期内径、左心室舒张早期充盈峰最大充盈速度/舒张晚期充盈峰最大峰值速度(E/A),并检测血清miR-29b表达。分析冠心病合并LVH患者血清miR-29b与心脏彩超指标水平之间的相关性,绘制受试者工作特征(receiver operating characteristic,ROC)曲线探讨心脏彩超指标、血清miR-29b对冠心病合并LVH的诊断效能,构建心脏彩超指标、血清miR-29b诊断冠心病合并LVH的回归预测模型,分析模型预测效能。结果LVH组左室后壁厚度、室间隔厚度、左心室舒张末期内径、血清miR-29b水平较非LVH组高,E/A水平较非LVH组低(P<0.05)。Pearson相关性分析显示,冠心病合并LVH患者血清miR-29b表达与左室后壁厚度、室间隔厚度、左心室舒张末期内径呈正相关,与E/A值呈负相关(r值分别为0.574、0.609、0.506、-0.628,P均<0.05)。绘制ROC曲线显示,心脏彩超指标、血清miR-29b均对诊断冠心病合并LVH具有良好效能。联合诊断时进行Logistic二元回归拟合,得出预测概率值logit(P),logit(P)=-29.027+9.964×左室后壁厚度(cm)+2.729×室间隔厚度(cm)+0.286×左心室舒张末期内径(mm)-7.958×E/A+2.716×血清miR-29b,H-L检验显示,χ^(2)=1.730,P=0.988,模型构建有效。ROC曲线发现,心脏彩超指标、血清miR-29b联合应用对冠心病合并LVH的诊断AUC为0.993,明显高于单一指标诊断,联合诊断的敏感度为95.59%,特异度为96.32%。结论心脏彩超联合miR-29b可提高冠心病合并LVH的诊断价值,为判定LVH提供可靠依据。

Objective To explore the diagnostic value of cardiac ultrasound combined with microRNA(miR)-29b for coronary heart disease(CHD)complicated by left ventricular hypertrophy(LVH).Methods A total of 68 patients with CHD and LVH admitted to the hospital from September 2018 to November 2023 were selected as the LVH group.Additionally,136 patients with CHD(without LVH)were selected as the non-LVH group.Both groups underwent cardiac ultrasound to measure relevant indices including left ventricular posterior wall thickness,interventricular septal thickness,left ventricular end-diastolic diameter,and peak early diastolic filling velocity/peak late diastolic filling velocity(E/A ratio).Serum miR-29b expression was also measured.The correlation between serum miR-29b and cardiac ultrasound indices in patients with CHD and LVH was analyzed.Receiver operating characteristic(ROC)curves were plotted to evaluate the diagnostic efficacy of cardiac ultrasound indices and serum miR-29b for CHD with LVH.A regression predictive model for diagnosing CHD with LVH using these markers was constructed and its predictive performance was analyzed.Results The LVH group had higher left ventricular posterior wall thickness,interventricular septal thickness,left ventricular end-diastolic diameter,and serum miR-29b levels compared with the non-LVH group,while the E/A ratio was lower(P<0.05).Pearson correlation analysis showed that serum miR-29b in CHD with LVH was positively correlated with left ventricular posterior wall thickness,interventricular septal thickness,and left ventricular end-diastolic diameter,and negatively correlated with the E/A ratio(r=0.574,0.609,0.506,-0.628,respectively;all P<0.05).ROC curve analysis showed that both cardiac ultrasound indices and serum miR-29b were efficacious for diagnosing CHD with LVH.The Logistic binary regression model for combined diagnosis yielded a predictive probability logit(P)=-29.027+9.964×left ventricular posterior wall thickness(cm)+2.729×interventricular septal thickness(cm)+0.286×left ventricular end-diastolic diameter(mm)-7.958×E/A+2.716×serum miR-29b.The Hosmer-Lemeshow test showed good model fit(χ^(2)=1.730,P=0.988).The ROC curve showed that the combined use of cardiac ultrasound indices and serum miR-29b had an AUC of 0.993 for diagnosing CHD with LVH,significantly higher than any single index.The combined diagnostic sensitivity was 95.59%,and the specificity was 96.32%.Conclusion The combination of cardiac ultrasound with miR-29b improves the diagnostic value for CHD with LVH,providing a reliable basis for determining LVH.