急性心肌梗死患者并发心力衰竭的高危因素及其与Toll样受体4/核因子-κB信号通路和微小核糖核酸-210信号通路和微小核糖核酸-210、微小核糖核酸-211的关系研究  

Risk factors for heart failure in patients with acute myocardial infarction and itsrelationship with Toll-like receptor 4/nuclear factor-κB signaling pathway and microRNA-210 signaling pathway and microRNA-210,microRNA-211 in patients with acute myocardial infarction

作　　者：程松建 刘思洋 蔡宏宇 CHENG Songjian;LIU Siyang;CAI Hongyu(Department of Cardiology,The First Affiliated Hospital of Jinzhou Medical University,Jinzhou 121000,China)

机构地区：[1]锦州医科大学附属第一医院,辽宁锦州121000

出　　处：《陕西医学杂志》2025年第4期480-486,共7页Shaanxi Medical Journal

基　　金：辽宁省教育厅基本科研面上项目(jytms20231725)。

摘　　要：目的:研究急性心肌梗死患者并发心力衰竭的高危因素及其与Toll样受体4(TLR4)/核因子-κB(NF-κB)信号通路和微小核糖核酸-210(miR-210)、微小核糖核酸-211(miR-221)的关系。方法:回顾性104例急性心肌梗死并发心力衰竭患者的临床资料作为心衰组,按照1∶1选取同期收治的104例急性心肌梗死未并发心力衰竭患者的临床资料作为无心衰组,统计两组一般资料,比较两组血清TLR4/NF-κB信号通路指标和miR-210、miR-221水平,分析急性心肌梗死患者并发心力衰竭的影响因素及血清TLR4/NF-κB信号通路指标和miR-210、miR-221对急性心肌梗死患者并发心力衰竭的诊断价值。结果:心衰组纽约心脏学会(NYHA)心功能分级Ⅲ/Ⅳ级患者占比及血清N末端脑钠肽前体(NT-proBNP)、肌酸激酶同工酶(CK-MB)水平高于无心衰组,左室射血分数(LVEF)低于无心衰组(均P<0.05)。实时荧光定量聚合酶链式反应检测结果表明,心衰组血清TLR4 miRNA、NF-κB mRNA、miR-210、miR-221水平高于无心衰组(均P<0.05)。NYHA心功能分级Ⅲ/Ⅳ级、LVEF较低及血清NT-proBNP、CK-MB、TLR4 mRNA、NF-κB mRNA、miR-210、miR-221水平较高均为急性心肌梗死患者并发心力衰竭的危险因素(OR=1.694、1.857、1.624、1.863、2.098、1.914、1.788、1.891,均P<0.05)。血清TLR4 mRNA、NF-κB mRNA、miR-210、miR-221联合诊断急性心肌梗死患者并发心力衰竭的曲线下面积(AUC)高于四者单独检测(均P<0.05)。结论:急性心肌梗死患者并发心力衰竭的危险因素包括NYHA心功能分级Ⅲ/Ⅳ级、LVEF较低及血清NT-proBNP、CK-MB、TLR4 mRNA、NF-κB mRNA、miR-210、miR-221水平较高,其中血清TLR4/NF-κB信号通路指标和miR-210、miR-221联合可有效提高对急性心肌梗死患者并发心力衰竭的诊断价值。Objective:To study the high risk factors of heart failure in patients with acute myocardial infarction and its relationship with Toll-like receptor 4(TLR4)/nuclear factor-κB(NF-κB)signaling pathway,microribonucleic acid-210(miR-210)and microribonucleic acid-211(miR-221).Methods:The clinical data of 104 patients with acute myocardial infarction complicated with heart failure admitted to the First Affiliated Hospital of Jinzhou Medical University from August 2023 to August 2024 were retrospectively collected as the heart failure group,and the clinical data of 104 patients with acute myocardial infarction without heart failure admitted to the same period were selected according to 1∶1 as the non-heart failure group.Serum levels of TLR4/NF-κB signaling pathway and miR-210 and miR-221 were detected by real-time fluorescence quantitative polymerase chain reaction.The general data of the two groups were counted,and the serum TLR4/NF-κB signaling pathway indexes and the levels of miR-210 and miR-221 were compared between the two groups.The influencing factors of heart failure in patients with acute myocardial infarction and the diagnostic value of serum TLR4/NF-κB signaling pathway indicators and miR-210 and miR-221 in patients with acute myocardial infarction complicated with heart failure were analyzed.Results:The proportion of patients with New York Heart Association(NYHA)cardiac function gradeⅢ/Ⅳand the levels of serum N-terminal pro-brain natriuretic peptide(NT-proBNP)and creatine kinase isoenzyme(CK-MB)in the heart failure group were higher than those in the non-heart failure group,and the left ventricular ejection fraction(LVEF)was lower than that in the non-heart failure group(all P<0.05).Real-time fluorescence quantitative polymerase chain reaction detection results showed that,the levels of serum TLR4 mRNA,NF-κB mRNA,miR-210 and miR-221 in the heart failure group were higher than those in the non-heart failure group(all P<0.05).NYHA cardiac function gradeⅢ/Ⅳ,lower LVEF and higher levels of serum

关 键 词：急性心肌梗死 心力衰竭 高危因素 TOLL样受体4 核因子-κB 信号通路 微小核糖核酸-210 

分 类 号：R541.4[医药卫生—心血管疾病]