心房颤动患者血清金属蛋白酶抑制剂4和微小核糖核酸-29b表达与心房纤维化和射频消融后复发的关系  

Relationship between serum TIMP4 mRNA and miR-29b expression and atrial fibrosis and recurrence after radiofrequency ablation in patients with atrial fibrillation

作　　者：杨艳 刘虹 李双菲 朱吉燕 张大勇 YANG Yan;LIU Hong;LI Shuang-fei;ZHU Ji-yan;ZHANG Da-yong(Departmeng of cardiovascular medicine,Sichuan Mianyang 404 Hospital(the First People’s Hospital of Mianyang city),Mianyang 621000,China)

机构地区：[1]四川绵阳四○四医院(绵阳市第一人民医院)心血管内科,四川省绵阳市621000

出　　处：《中国心血管病研究》2024年第12期1090-1095,共6页Chinese Journal of Cardiovascular Research

基　　金：四川省临床重点专科建设项目经费资助(19PJ105)。

摘　　要：目的探讨心房颤动(AF)患者血清基质金属蛋白酶抑制剂4(TIMP4)mRNA、微小核糖核酸(miR)-29b表达与心房纤维化的关系,分析其与射频消融后复发的相关性。方法选择四川绵阳四○四医院2022年1月至2023年6月期间收治的AF患者142例(病例组)和健康体检者90例(对照组),病例组根据复发情况分为复发组(56例)和未复发组(86例),比较两组TIMP4 mRNA、miR-29b、Ⅰ型前胶原氨基端前肽(PⅠNP)、Ⅲ型前胶原氨基端前肽(PⅢNP)和层黏连蛋白水平(LN);分析病例组TIMP4 mRNA、miR-29b与纤维化指标的相关性;分析AF射频消融后复发的相关因素,分析TIMP4 mRNA、miR-29b对AF射频消融后复发的预测价值。结果病例组外周血TIMP4 mRNA[(0.64±0.22)比(1.39±0.42)]、miR-29b[(0.59±0.20)比(1.13±0.35)]相对表达量低于对照组(P<0.01),血清PⅠNP[(121.09±10.14)μg/L比(71.38±8.42)μg/L]、PⅢNP[(6.86±2.20)μg/L比(4.31±1.28)μg/L]、LN[(138.25±12.99)μg/L比(94.53±10.67)μg/L]均高于对照组(P<0.01);病例组TIMP4 mRNA、miR-29b与PⅠNP、PⅢNP、LN均呈负相关(P<0.05,P<0.01);复发组左心房内径(LAD)、肌酐(Cr)、尿酸(UA)、PⅠNP、PⅢNP、LN均高于未复发组(P<0.01)TIMP4 mRNA、miR-29b均低于未复发组(P<0.01);多因素logistic回归分析显示,LAD、PⅢNP、LN、TIMP4 mRNA、miR-29b为AF射频消融后复发的独立危险因素;TIMP4 mRNA联合miR-29b预测AF射频消融后复发的AUC为0.912(95%CI 0.831~0.961),高于单独预测(Z=2.872、2.611,P=0.009、0.012)。结论AF患者血清TIMP4 mRNA、miR-29b表达与心房纤维化程度呈负相关,TIMP4 mRNA、miR-29b低表达是AF射频消融后复发的独立危险因素,二个指标联合应用预测AF射频消融后复发具有较高的临床效果。Objective To explore the relationship between the expressionof serum matrix metalloproteinase inhibitor 4(TIMP4)mRNA,microribonucleic acid(miR-29b)in patients with atrial fibrillation(AF)and atrial fibrosis,and to analyze the correlation with recurrence after radiofrequency ablation.Method 142 patients with AF admitted to Sichuan Mianyang 404 Hospital from January,2022 to June,2023(the case group)and 90 healthy individuals(the control group)were selected.According to the recurrence situation,the patients were divided into the case group and the recurrence group(56 cases)and the non recurrence group(86 cases).The TIMP4 mRNA,miR-29b,typeⅠprocollagen N-terminal propeptide(PⅠNP),typeⅢprocollagen N-terminal propeptide(PⅢNP)and laminin(LN)in the case group were compared between the two groups;The correlation between TIMP4 mRNA,miR-29b and fibrosis indicators in the case group and the relevant factors of recurrence after AF radiofrequency ablation,and evaluation of the predictive value of TIMP4 mRNA and miR-29b for recurrence after AF radiofrequency ablation were analyzed.Results The relative expression levels of TIMP4 mRNA and miR-29b in the peripheral blood of the case group were lower than those of the control group(P<0.01),and the serum levels of PⅠNP,PⅢNP and LN were higher than those of the control group(P<0.01);the TIMP4 mRNA and miR-29b of the case group were negatively correlated with PⅠNP,PⅢNP and LN(P<0.05,P<0.01);left atrial diameter(LAD),creatinine(Cr),uric acid(UA),PⅠNP,PⅢNP,and LN of the recurrent group were higher than those of the non recurrent group(P<0.01),and TIMP4 mRNA and miR-29b were lower than those of the non recurrent group(P<0.01).Multivariate logistic regression analysis showed that LAD,PⅢNP,LN,TIMP4 mRNA,and miR-29b were the independent risk factors for recurrence after radiofrequency ablation;The AUC of ofrecurrence after AF radiofrequency ablation predicted with the combination of TIMP4 mRNA and miR-29b was 0.912(95%CI 0.831-0.961),which was higher than the prediction

关 键 词：心房颤动 基质金属蛋白酶抑制剂4 微小核糖核酸-29b 心房纤维化 射频消融 复发 

分 类 号：R541.7[医药卫生—心血管疾病]