慢性心力衰竭合并肺部感染患者MIP-2、MMP-9、D-D、miR-21表达及与病原菌类型、心肌功能的关联性研究  

Expressions of MIP-2,MMP-9,D-D and miR-21 in Patients with Chronic Heart Failure Complicated by Pulmonary Infection and Their Correlations with Pathogen Types and Myocardial Function

作　　者：鲍利改 董谦[2] BAO Li-gai;DONG Qian(Department of General Medicine,Liangxiang Hospital of Fangshan District,Beijing 102488,China;Department of Internal Medicine,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100069,China)

机构地区：[1]北京市房山区良乡医院全科医学科,北京102488 [2]首都医科大学附属北京朝阳医院内科,北京100069

出　　处：《临床误诊误治》2022年第3期78-83,共6页Clinical Misdiagnosis & Mistherapy

基　　金：北京市科学技术委员会科研课题(D141100000114003)。

摘　　要：目的探讨慢性心力衰竭(CHF)合并肺部感染(PI)患者巨噬细胞炎症蛋白-2(MIP-2)、基质金属蛋白酶-9(MMP-9)、D-二聚体(D-D)、微小核糖核酸-21(miR-21)表达及与病原菌类型、心肌功能的关联性。方法选取2018年1月—2020年4月我院214例CHF,根据是否合并PI分为PI组78例与无PI组136例。比较2组一般资料,采用多因素Logistic回归分析探讨CHF合并PI的影响因素;分析CHF合并PI患者心肌功能指数(MPI)与MIP-2、MMP-9、D-D、miR-21的相关性;分析MIP-2、MMP-9、D-D、miR-21联合检测对CHF合并PI的诊断价值;分析CHF合并PI患者病原菌类型及MIP-2、MMP-9、D-D、miR-21与病原菌类型的相关性。结果年龄、白细胞计数、中性粒细胞百分比、淋巴细胞百分比、心功能分级、MPI、肌酸激酶(CK)、天冬氨酸转氨酶(AST)、心肌型肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、MIP-2、MMP-9、D-D、miR-21为CHF合并PI的独立危险因素(P<0.05)。CHF合并PI患者MIP-2、MMP-9、D-D、miR-21表达均与MPI呈正相关(r=0.870、0.883、0.935、0.766,P<0.01)。受试者工作特征曲线分析显示,MIP-2、MMP-9、D-D、miR-21联合检测诊断CHF合并PI的曲线下面积最大(0.917),敏感度、特异度分别为74.36%、91.91%。78例CHF合并PI痰液标本共检出病原菌87株,其中革兰阴性菌62株(71.26%),革兰阳性菌21株(24.14%),真菌4株(4.60%)。MIP-2、MMP-9、D-D、miR-21与病原菌类型呈正相关(r=0.785、0.625、0.617、0.734,P<0.05)。结论MIP-2、MMP-9、D-D、miR-21在CHF合并PI患者中异常高表达,并与病原菌类型、心肌功能存在一定相关性,早期联合检测可为临床诊治、病原菌类型鉴别、心肌功能评估提供参考。Objective To investigate expressions of macrophage inflammatory protein-2(MIP-2),matrix metalloproteinase-9(MMP-9),D-Dimer(D-D)and microRNA-21(miR-21)in patients with chronic heart failure(CHF)complicated by pulmonary infection(PI)and their correlations with pathogen types and myocardial function.Methods A total of 214 patients with CHF between January 2018 and April 2020 were selected and divided into PI group(n=78)and non-PI group(n=136)according to presence or absence of complicated by PI.General data was compared between two groups,and the influencing factors of CHF complicated by PI were discussed by multivariate Logistic regression analysis.Correlations between myocardial performance index(MPI)with MIP-2,MMP-9,D-D and miR-21 of patients with CHF complicated by PI were analyzed,and the value of combined detection of MIP-2,MMP-9,D-D and miR-21 in diagnosis of patients with CHF complicated by PI was explored.The types of pathogens in patients with CHF complicated by PI and their correlations with MIP-2,MMP-9,D-D and miR-21 were analyzed.Results Age,leukocyte count,neutrophil percentage,lymphocyte percentage,cardiac function grade,MPI,creatine kinase(CK),aspartate aminotransferase(AST),myocardial creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),MIP-2,MMP-9,D-D and miR-21 were independent risk factors for patients with CHF complicated by PI(P<0.05).Expressions of MIP-2,MMP-9,D-D and miR-21 in patients with CHF complicated by PI were positively correlated with MPI(r=0.870,0.883,0.935 and 0.766,P<0.01).Receiver operating characteristic(ROC)curve showed that the area under the ROC curve of combined detection of MIP-2,MMP-9,D-D and miR-21 in diagnosis of patients with CHF complicated by PI was the largest(0.917),and its sensitivity and specificity were 74.36% and 91.91% respectively.A total of 87 strains of pathogenic bacteria were detected in sputum samples of 78 patients with CHF complicated by PI,in which there were 62 strains of gram-negative bacteria(71.26%),21 strains of gram-positive bacteria(24.14

关 键 词：心力衰竭 肺部感染 巨噬细胞炎症蛋白-2 基质金属蛋白酶-9 D-二聚体 微小核糖核酸-21 病原菌类型 心肌功能 诊断价值 相关性 

分 类 号：R541.6[医药卫生—心血管疾病] R563.1[医药卫生—内科学]