慢性心力衰竭患者血清微小核糖核酸-29b表达水平及其临床意义  

Expression level and clinical significance of serum microRNA-29b in patients with chronic heart failure

作　　者：周娇鸣 王永红 费爱科[1] 李利[1] 曾卓 Zhou Jiaoming;Wang Yonghong;Fei Aike;Li Li;Zeng Zhuo(Department of Cardiovascular,the Fourth Hospital of Changsha(Changsha Hospital Affiliated with Hunan Normal University),Changsha 410000,China)

机构地区：[1]长沙市第四医院(湖南师范大学附属长沙医院)心血管内科,410000

出　　处：《心脑血管病防治》2024年第4期36-40,44,共6页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的探讨慢性心力衰竭(CHF)患者血清中微小核糖核酸-29b(miR-29b)的表达水平及其临床意义。方法选取2017年6月至2020年8月长沙市第四医院收治的167例CHF患者作为观察组,并根据纽约心脏协会心功能分级标准进行分级;另选同时间段内145名健康体检者为对照组。采用qRT-PCR检测受试者血清miR-29b表达水平,超声心动图检测左心房内径(LAD)、左心室重构指数(LVRI)、左心室舒张末期内径(LVEDD)、左心室后壁厚度(LVPWD)、左心室质量指数(LVMI)、左心室射血分数(LVEF)、心排血量(CO),并检测血清N末端B型脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)、心肌肌钙蛋白T(cTnT)水平及评估堪萨斯城心肌病调查问卷(KCCQ)评分、6 min步行试验(6MWT)。比较对照组和观察组各级心功能患者上述各项指标,采用Pearson相关性分析法分析观察组患者血清miR-29b表达水平与心功能、心室重构指标及生存质量的关系;随访1年,采用多因素Logistic回归分析法分析CHF患者血清miR-29b表达水平与预后的关系。结果观察组心功能Ⅱ级、Ⅲ级、Ⅳ级患者中血清miR-29b相对表达量、LVRI、CO、LVEF及KCCQ评分、6MWT均依次降低(P<0.05),且均低于对照组(F=831.833、386.491、110.251、71.503、101.552、867.632,P<0.05);观察组心功能Ⅱ级、Ⅲ级、Ⅳ级中LAD、LVEDD、LVMI、LVPWD及血清NT-proBNP、cTnI、cTnT水平均依次升高(P<0.05),且均高于对照组(F=238.758、528.524、241.700、58.167、3712.854、1836.663、2230.468,P<0.05);Pearson相关性分析显示CHF患者miR-29b表达与LVEDD、LVPWD、LVMI、LAD及血清NT-proBNP、cTnI、cTnT水平均呈负相关(r=-0.822、-0.884、-0.891、-0.713、-0.854、-0.813、-0.832,P<0.05),而与LVEF、CO、LVRI及KCCQ评分、6MWT均呈正相关(r=0.734、0.864、0.791、0.721、0.783,P<0.05);多因素Logistic回归分析显示血清miR-29b表达是CHF患者预后不良的保护因素(OR=0.517,P<0.05),心功能分级Ⅲ/Ⅳ级和对医嘱依Objective To investigate the expression level of microRNA-29b(miR-29b)in the serum of patients with chronic heart failure(CHF)and its clinical significance.Methods A total of 167 CHF patients admitted to the Fourth Hospital of Changsha from June 2017 to August 2020 were selected as the observation group,and they were classified according to the New York Heart Association(NYHA)classification criteria.A total of 145 healthy individuals undergoing physical examinations during the same period were selected as the control group.Quantitative real-time polymerase chain reaction(qRT-PCR)was used to detect serum expression of miR-29b.Left atrial diameter(LAD),left ventricular remodelling index(LVRI),left ventricular end diastolic diameter(LVEDD),left ventricular posterior wall depth(LVPWD)and left ventricular mass index(LVMI),left ventricular ejection fraction(LVEF),and cardiac output(CO)were measured by echocardiography.Serum levels of N-terminal pro brain natriuretic peptide(NT-proBNP),cardiac troponin I(cTnI),and cardiac troponin T(cTnT)were measured,and the Kansas City Cardiomyopathy Questionnaire(KCCQ)score and 6 min walk test(6MWT)were assessed.The above indicators between the control group and the patients with different functional grades in the observation group were compared.The relationship between serum miR-29b expression level and cardiac function,ventricular remodeling index,and quality of life in the observation group was analyzed by Pearson correlation analysis.A one-year follow-up was conducted,and the relationship between serum miR-29b expression level and prognosis in CHF patients was analyzed by multivariate Logistic regression.Results In the observation group,the relative expression levels of serum miR-29b,LVRI,CO,LVEF,KCCQ scores,and 6MWT all decreased gradually in NYHA gradeⅡ,ⅢandⅣpatients(P<0.05),and were all lower than those in the control group(F=831.833,386.491,110.251,71.503,101.552,867.632;P<0.05).The LAD,LVEDD,LVMI,LVPWD,and the levels of serum NT-proBNP,cTnI,cTnT all increased successiv

关 键 词：慢性心力衰竭 微小核糖核酸-29b 预后 心肌重构 心功能 

分 类 号：R541.6[医药卫生—心血管疾病]