循环游离线粒体DNA对慢性心力衰竭病情判断及预后的价值  

Significance of circulating cell-free mitochondrial DNA in patients with chronic heart failure

作　　者：谢启海 许向东[1] 王立芳 刘莉 徐荣 XIE Qi-hai;XU Xiang-dong;WANG Li-fang;LIU Li;XU Rong(Department of Cardiovascular Medicine,Jiading District Central Hospital Affiliated to Shanghai Medical College of Health,Shanghai 201800;Department of Renal Medicine,Jiading District Central Hospital Affiliated to Shanghai Medical College of Health,Shanghai 201800;Department of Ultrasound,Jiading District Central Hospital Affiliated to Shanghai Medical College of Health,Shanghai 201800,China)

机构地区：[1]上海健康医学院附属嘉定区中心医院心血管内科,上海201800 [2]上海健康医学院附属嘉定区中心医院肾内科,上海201800 [3]上海健康医学院附属嘉定区中心医院超声科,上海201800

出　　处：《热带医学杂志》2020年第7期945-949,共5页Journal of Tropical Medicine

基　　金：上海市医学重点专科(2019C03);上海健康医学院附属嘉定区中心医院第十五批中青年骨干培养计划资助(ZQN201701)。

摘　　要：目的探讨循环游离线粒体DNA(ccf mtDNA)对慢性心力衰竭(CHF)病情判断及预后的价值。方法选取2017年7月-2018年12月于上海健康医学院附属嘉定区中心医院心内科住院治疗的50例CHFⅣ级患者为研究对象(CHF组);同期选取健康体检者50例作为对照(对照组);根据出院90 d内是否发生心血管事件将CHF患者分为心血管事件组和非事件组。两组一般资料分析;采用实时荧光定量PCR(qRT-PCR)法检测血清ccf mtDNA水平;分析CHF患者近期不同预后组血清ccf mtDNA水平及心力衰竭指标;分析CHF患者血清ccf mtDNA水平与心力衰竭指标相关性;分析影响CHF患者近期预后的因素。结果两组性别、年龄、BMI、吸烟比例、患高血压比例、高血脂比例、肌酐比较,差异均无统计学意义(P>0.05)。CHF组ccf mtDNA、超敏C-反应蛋白(hs-CRP)、氨基N末端B型利钠肽前体(NT-proBNP)、左室舒张末期内径(LVEDD)、左室收缩末内径(LVESD)显著高于对照组,左心室射血分数(LVEF)、左室短轴缩短率(LVFS)显著低于对照组,差异均有统计学意义(P<0.05)。CHF患者发生心血管事件组ccf mtDNA、hs-CRP、NT-proBNP、LVEDD、LVESD显著高于非事件组,LVEF、LVFS显著低于非事件组,差异均有统计学意义(P<0.05)。CHF患者血清中ccf mtDNA水平与hs-CRP、NT-proBNP、LVEDD、LVESD均呈正相关(P<0.05),与LVEF、LVFS呈负相关(P<0.05)。ccf mtDNA、hs-CRP、NT-proBNP是影响CHF患者发生心血管事件不良预后的危险因素,LVEF、LVFS是影响CHF患者发生心血管事件不良预后的保护因素。结论血清ccf mtDNA水平对CHF病情诊断及预后评定均具有重要意义。Objective To evaluate the significance of circulating cell-free mitochondrial DNA(ccf mtDNA)in the serum of patients with chronic heart failure(CHF).Methods From July 2017 to December 2018,50 patients with grade IV CHF enrolled in Jiading District Central Hospital Affiliated to Shanghai Medical College of Health were selected as the study objects(CHF group);at the same time,50 healthy people were selected as the control group;and CHF patients were divided into cardiovascular event group and nonevent group according to whether cardiovascular events occurred within 90 days after discharge.The general data of two groups were analyzed;the ccf mtDNA level in serum was detected by real-time fluorescent quantitative PCR(qRT-PCR);the levels of serum ccf mtDNA and heart failure indexes in different prognosis groups were analyzed;the correlation between serum ccf mtDNA level and heart failure index was analyzed;and the multiple factors influencing the short-term prognosis of CHF patients were analyzed.Results There was no significant difference in sex,age,BMI,smoking rate,hypertension rate,hyperlipidemia rate and creatinine between the two groups(P>0.05);in CHF group,ccf mtDNA,hypersen sitive C-reactive(hs-CRP),N-terminal pro-B-type natriuretic peptide(NTproBNP),left ventricular end diastolic dimension(LVEDD)and left ventricular end systolic diameter(LVESD)were significantly higher than those in control group,and left ventricular ejection fraction(LVEF)and left ventricular fraction shortening(LVFS)were significantly lower than those in control group(P<0.05);ccf mtDNA,hs-CRP,NT-proBNP,LVEDD and LVESD of CHF patients in cardiovascular event group were significantly higher than those in non-cardiovascular event group(P<0.05),and LVEF and LVFS were significantly lower than those in non-cardiovascular event group(P<0.05);the level of ccf mtDNA of CHF patients was positively correlated with hs-CRP,NT-proBNP,LVEDD and LVESD(P<0.05),and negatively correlated with LVEF and LVFS(P<0.05);ccf mtDNA,hs-CRP and NT-proBNP were risk facto

关 键 词：慢性心力衰竭 血清 循环游离线粒体DNA 预后 

分 类 号：R541[医药卫生—心血管疾病]