摘要
目的 分析慢性心力衰竭(CHF)患者中西医结合治疗前后彩超参数及微小RNAs(miRNAs)检测的临床意义.方法 选取2020 年1 月至2023 年4 月收治的162 例CHF为研究对象,根据纽约心脏协会心功能分级分为心功能Ⅱ级组(n=47),心功能Ⅲ级组(n=75),心功能Ⅳ级组(n=40).比较不同心功能分级CHF治疗前后彩超参数[左心室射血分数(LVEF)、左心房内径(LAD)、左心室舒张末内径(LVEDd)]及miRNAs(miRNA-208、miRNA-130a)表达水平.分析彩超参数、miRNAs与心功能分级的相关性,比较不同预后CHF患者彩超参数、miRNAs表达水平,并分析其对中西医结合治疗预后的评估价值.结果 治疗前后,心功能Ⅱ级组LVEF＞心功能Ⅲ级组＞心功能Ⅳ级组,心功能Ⅱ级组LAD、LVEDd及miRNA-208、miRNA-130a表达水平＜心功能Ⅲ级组＜心功能Ⅳ级组(P＜0.05).不同心功能分级CHF患者中西医结合治疗后LVEF水平均较治疗前升高,LAD、LVEDd及miRNA-208、miRNA-130a表达水平均较治疗前降低(P＜0.05).治疗前后,LVEF与CHF患者心功能分级呈负相关,而LAD、LVEDd及miRNA-208、miRNA-130a表达与心功能分级呈正相关(P＜0.01).治疗前后,预后不良组LVEF均低于预后良好组,LAD、LVEDd及miRNA-208、miRNA-130a表达水平均高于预后良好组(P＜0.05).不同预后CHF患者治疗后LVEF均较治疗前升高,LAD、LVEDd及miRNA-208、miRNA-130a表达水平均较治疗前降低(P＜0.05).治疗前后彩超参数及miRNAs检测联合评估CHF患者预后的曲线下面积最大,分别为 0.915(95%CI:0.861,0.953)、0.943(95%CI:0.896,0.974).结论 CHF患者中西医结合治疗前后彩超参数及miRNA-208、miRNA-130a表达与心功能分级关系密切,联合检测彩超参数、miRNAs对CHF预后有较高评估价值.
Abstract
Objective To analyze the clinical significance of color Doppler ultrasound parameters and microRNAs(miRNAs)detection in patients with chronic heart failure(CHF)before and after treatment with combined traditional Chinese medicine(TCM)and Western medicine.Methods A total of 162 patients with CHF admitted from January 2020 to April 2023 were selected as the research subjects and divided into cardiac function Ⅱ group(n=47),cardiac function Ⅲ group(n=75),and cardiac function Ⅳ group(n=40)according to the New York Heart Association cardiac function classifica-tion.The color Doppler ultrasound parameters[left ventricular ejection fraction(LVEF),left atrial diameter(LAD)and left ventricular end diastolic diameter(LVEDd)]and the expression levels of miRNAs(miRNA-208,miRNA-130a)were com-pared before and after the treatment for CHF with different cardiac function classifications.The correlation between color Doppler ultrasound parameters,miRNAs and cardiac function classifications was analyzed,the color Doppler ultrasound pa-rameters and expression levels of miRNAs in patients with CHF with different prognosis were compared,and their prognostic value for the treatment with combined TCM and Western medicine was analyzed.Results Before and after treatment,LVEF in cardiac function Ⅱgroup was the highest followed by cardiac functionⅢgroup and cardiac functionⅣgroup,while LAD,LVEDd,and miRNA-208 and miRNA-130a expression levels were the lowest in cardiac functionⅡgroup,followed by cardiac function class Ⅲ group and cardiac function class Ⅳ group(P＜0.05).After treatment,compared with those before treat-ment,with combined TCM and Western medicine,the LVEF level in patients with CHF of different cardiac function classifica-tions was increased,while LAD,LVEDd,miRNA-208,and miRNA-130a expression levels were decreased(P＜0.05).Be-fore and after treatment,LVEF was negatively correlated with the cardiac function in patients with CHF,while LAD,LVEDd,and miRNA-208,and miRNA-130a expression were positively correlated with the cardiac function classifications(P＜0.01).Before and after treatment,the LVEF in the poor prognosis group was lower than that in the good prognosis group,while the LAD,LVEDd,and miRNA-208 and miRNA-130a expression levels were higher than those in the good prognosis group(P＜0.05).After treatment,compared with those before treatment,LVEF in patients with CHF of different prognoses was in-creased,while LAD,LVEDd,and miRNA-208 and miRNA-130a expression levels were decreased(P＜0.05).The area un-der the curve of the combined detection of color Doppler ultrasound parameters and miRNAs before and after treatment in eval-uating the prognosis of CHF patients was the largest,with the values of 0.915(95%CI:0.861,0.953)and 0.943(95%CI:0.896,0.974),respectively.Conclusion Color Doppler ultrasound parameters,miRNA-208 and miRNA-130a expression are closely related to cardiac function classifications in CHF patients before and after treatment with combined TCM and Western medicine,the combined detection of color Doppler ultrasound parameters and miRNAs has high evaluation value for the prognosis of CH.
基金项目
张家口市重点研发计划项目(卫生健康和生物医疗专项)(300600)
国家科技期刊平台
NSTL
万方数据