血清ADMA、BNP、miRNAs与先天性心脏病合并肺动脉高压关系的研究  

Relevance of serum BNP, ADMA, miRNAs and pulmonary arterial hypertension in children with congenital heart disease

作　　者：黄勇[1] 李蔚华[1] 尹虹[1] 饶红[1] Huang Yong;Li Weihua;Yin Hong;Rao Hong(Department of Cardiology,Liyuan hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430077,China)

机构地区：[1]华中科技大学同济医学院附属梨园医院心血管内科,武汉430077

出　　处：《中国循证心血管医学杂志》2018年第10期1216-1219,1223,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：武汉市卫生计生委科研项目(WX17B35)

摘　　要：目的筛选与先天性心脏病(CHD)合并肺动脉高压(PAH)相关的血清微小RNA(miRNAs),并探讨与脑钠肽(BNP)和不对称二甲基精氨酸(ADMA)的相关性以及对CHD合并PAH的临床诊断价值。方法选择2016年9月～2018年1月于华中科技大学同济医学院附属梨园医院儿科就诊的CHD患儿82例,根据右心导管检查结果,53例患儿为CHD合并PAH(CHD+PAH组),其余29例患儿未合并PAH(CHD组)。采集静脉血,采用基因芯片技术筛选两组患儿有表达差异的miRNAs,并进行实时荧光定量逆转录聚合酶链反应(qRT-PCR)验证,比较两组患儿血液生化指标的差异。结果CHD+PAH患儿平均肺动脉压(mPAP)、血清BNP、ADMA水平均高于CHD组患儿(P<0.05)。经基因芯片分析,两组患儿hsa-miR-23a、hsa-miR-29c、hsa-miR-191、hsa-miR-93表达存在显著差异。经qRT-PCR分析,CHD+PAH组患儿外周血中miR-23a和miR-29c表达显著上调,而miR-191表达显著下调(P<0.05)。经Spearman等级相关性分析,CHD+PAH组患儿外周血miR-23a与BNP、ADMA、mPAP呈正相关性(P<0.05);miR-191与BNP、ADMA、mPAP呈负相关性(P<0.05)。经ROC曲线分析,外周血ADMA、BNP、miR-23a、miR-191以及联合诊断的曲线下面积分别为0.625,0.647,0.638,0.576,0.923,比较检测效能,差异有统计学意义(χ2=19.887,P<0.05)。结论血清miR-23a、miR-191水平可作为CHD患儿发生PAH的早期预测因子,且联合ADMA、BNP诊断效能更高。Objective To screen serum miRNAs related with pulmonary arterial hypertension(PAH)in children with congenital heart disease(CHD);to investigate the predictive value of miRNAs combined with brain natriuretic peptide(BNP)and asymmetric dimethyl-L-arginine(ADMA)on CHD-PAH.Methods 82 CHD children in our hospital were selected from september 2016 to January 2018 and divided into patients with PAH(CHD+PAH group,n=53)and patients without PAH group(CHD group,n=29).MiRNAs and mRNA expression profiles were determined in blood samples from CHD patients and CHD+PAH patients.The levels of plasma miRNAs,BNP and ADMA were detected and compared between the two groups.Results The serum levels of mean pulmonary arterial pressure(mPAP),BNP,ADMA in CHD+PAH group were higher than CHD group and(P<0.05).There was statistical difference of the baseline values of hsa-miR-23a,hsa-miR-29c,hsa-miR-191 and hsamiR-93 between CHD group and CHD+PAH group(P<0.05).The serum miR-23a and miR-29c expressions in peripheral blood of CHD+PAH patients were higher than CHD patients(P<0.05).And the serum miR-191 and miR-93 expressions in peripheral blood of CHD+PAH patients were lower than CHD patients(P<0.05).By Spearman analysis,miR-23a expression was positive related with BNP,ADMA,mPAP,which was negative related with miR-191(P<0.05).The AUC of ROC curve of ADMA,BNP,miR-23a,miR-191 and combination were 0.625,0.647,0.638,0.576,0.923(χ2=19.887,P<0.05).Conclusion It’s suggested that miR-23a,miR-191 combined with ADMA,BNP be the sensitive predictors of PAH in children with CHD.

关 键 词：先天性心脏病 肺动脉高压 MIRNAS ADMA BNP 

分 类 号：R543.2[医药卫生—心血管疾病]