外周血piR-hsa-2700592在房颤患者预后中的预测研究  

Predictive value of peripheral blood piR-hsa-2700592 for prognosis of atrial fibrillation patients

作　　者：杨蕾 邬娜[2] 杨岚清 陈彦秀 陈兴华 袁志权 李成英 吴龙[2] 曾雨虹 王煜 钟理 杨敬源[1] 李亚斐[2] YANG Lei;WU Na;YANG Lanqing;CHEN Yanxiu;CHEN Xinghua;YUAN Zhiquan;LI Chengying;WU Long;ZENG Yuhong;WANG Yu;ZHONG Li;YANG Jingyuan;LI Yafei(School of Public Health,Key Laboratory of Environmental Pollution Monitoring and Disease Control of Ministry of Education,Guizhou Medical University,Guiyang,Guizhou;Department of Epidemiology,Faculty of Military Preventive Medicine,Army Medical University(Third Military Medical University),Chongqing;Department of Cardiology,First Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing;Center for Cardiovascular Diseases,the Third Affiliated Hospital of Chongqing Medical University,Chongqing,China)

机构地区：[1]贵州医科大学公共卫生与健康学院,环境污染与疾病监控教育部重点实验室,贵阳 [2]陆军军医大学(第三军医大学)军事预防医学系军队流行病学教研室,重庆 [3]陆军军医大学(第三军医大学)第一附属医院心内科,重庆 [4]重庆医科大学附属第三医院心血管疾病中心,重庆

出　　处：《陆军军医大学学报》2025年第6期551-560,共10页Journal of Army Medical University

基　　金：国家自然科学基金面上项目(82073649)。

摘　　要：目的探究外周血piR-hsa-2700592与房颤患者全因死亡和卒中结局的关联,确定piRhsa-2700592是否具有作为房颤生物标志物的潜力。方法纳入127名非瓣膜性房颤患者,检测血浆piR-hsa-2700592相对表达水平,运用Cox比例风险回归分析外周血piR-hsa-2700592的相对表达水平与房颤患者全因死亡和卒中结局的关联。比较分析在CHA_(2)DS_(2)-VASc评分及ABC卒中(或死亡)评分中分别加入血浆piR-hsa-2700592表达水平后,其新预测模型对2种结局预测能力的改善情况。应用受试者工作特征曲线下面积(area under the curve,AUC)、净重新分类指数(net reclassification improvement,NRI)、综合判别改善指数(integrated discrimination improvement,IDI)评估预测能力,通过决策曲线分析(decision curve analysis,DC A)比较临床净收益情况。结果多因素Cox回归分析显示,外周血piR-hsa-2700592高表达水平的患者发生卒中的风险更高(HR:2.203;95%CI:1.120~4.332;P=0.022)。在卒中结局中,将血浆piR-hsa-2700592表达水平分别纳入CHA_(2)DS_(2)-VASc评分及ABC卒中评分相较原评分AUC有显著增加,其新模型AUC分别为0.70(95%CI:0.55~0.85,P<0.001)和0.84(95%CI:0.73~0.96,P=0.02);高血浆piR-hsa-2700592水平与房颤患者全因死亡无显著关联(HR:1.997;95%CI:0.884~4.509;P=0.096)。新模型的重分类能力得到显著改善,与CHA_(2)DS_(2)-VASc评分相比其NRI和IDI分别为44.20%(95%CI:3.40~59.90,P<0.001)和8.20%(95%CI:0.60~15.40,P<0.001);与ABC卒中评分相比,NRI和IDI分别为44.20%(95%CI:9.80~58.90,P<0.001)和10.40%(95%CI:0.70~21.40,P<0.001);DCA曲线显示其新预测模型均有更好的净临床获益。结论外周血高表达的piR-hsa-2700592是房颤患者发生卒中的独立危险因素,并且对房颤患者的预后有较好的预测价值,提示piRhsa-2700592可作为潜在生物标志物,为其在心血管疾病诊断和防治中的应用提供依据。Objectives To explore the association of peripheral blood PIWI-interacting RNA,piR-hsa-2700592,with all-cause mortality and stroke outcomes in patients with atrial fibrillation(AF),and to determine whether piR-hsa-2700592 has the potential to be an AF biomarker.Methods A total of 127 patients with non-valvular AF were enrolled,and the relative expression level of plasma piR-hsa-2700592 was detected.Cox proportional hazard regression was used to analyze the correlation between the expression of piR-hsa-2700592 and all-cause death as well as stroke outcome in the patients.Then the molecule expression level was combined with CHA_(2)DS_(2)-VASc score and ABC stroke(or death)score to establish 2 new prediction models,the improvement of the predictive performance was compared and analyzed.Receiver operating characteristic(ROC)curve analysis(area under the curve,AUC),net reclassification index(NRI),and comprehensive discriminant improvement index(IDI)were used to evaluate the predictive performance,and decision curve analysis(DCA)was employed to assess the clinical benefit.Results Multivariate Cox regression analysis showed that the patients with higher expression level of piR-hsa-2700592 in peripheral blood had a higher risk of stroke(HR:2.203,95%CI:1.120~4.332;P=0.022).In the stroke outcome,combination of plasma piR-hsa-2700592 expression level with CHA_(2)DS_(2)-VASc score and ABC stroke score obtained an AUC of 0.70(95%CI:0.55~0.85,P<0.001)and 0.84(95%CI:0.73~0.96,P=0.02),respectively.But,no significant association was observed between high plasma piR-hsa-2700592 level and all-cause mortality in the AF patients(HR:1.997;95%CI:0.884~4.509;P=0.096).Combination of plasma piR-hsa-2700592 level improved the discriminative capability than the single CHA_(2)DS_(2)-VASc score and ABC stroke score models,with an NRI and IDI value of 44.20%(95%CI:3.40~59.90,P<0.001)and 8.20%(95%CI:0.60~15.40,P<0.001),respectively for the new CHA_(2)DS_(2)-VASc score model,and an NRI and IDI value of 44.20%(95%CI:9.80~58.90,P<0.001)and 10.40%(

关 键 词：心房颤动 CHA_(2)DS_(2)-VASc评分 PIRNA 预后 

分 类 号：R181.23[医药卫生—流行病学] R446.119[医药卫生—公共卫生与预防医学] R541.75