摘要
目的 探讨血清微小RNA-451a(miR-451a)表达水平与急性心肌梗死(AMI)经皮冠状动脉介入治疗(PCI)术后并发心力衰竭(HF)的关系.方法 选取2019年11月至2021年2月于南通大学附属如皋医院行PCI的ST段抬高型心肌梗死(STEMI)患者140例进行研究,按PCI术后是否并发HF分为无HF组106例和HF组34例.比较两组临床资料及血清miR-451a、巨噬细胞移动抑制因子(MIF)水平;分析PCI术后并发HF的STEMI患者血清miR-451a水平与MIF的相关性;分析影响STEMI患者PCI术后发生HF的因素;分析血清miR-451a、MIF对STEMI患者PCI术后并发HF的预测价值.结果 HF组年龄≥60岁、病变支数≥2支、糖尿病、发病至行PCI时间≥12 h、高血压、高脂血症的患者占比及血清MIF水平高于无HF组(P<0.05),左心室射血分数(LVEF)≥50％的患者占比及血清miR-451a表达水平低于无HF组(P<0.05);PCI术后并发HF的STEMI患者血清miR-451a水平与MIF呈负相关(r=-0.484,P<0.05);miR-451a、LVEF是STEMI患者PCI术后发生HF的保护因素(OR=0.553、0.679,P<0.05),年龄、发病至行PCI时间、糖尿病、血管病变支数、高脂血症、高血压、MIF是STEMI患者PCI术后发生HF的危险因素(OR=2.208、2.187、2.572、2.394、2.456、2.630、2.781,P<0.05).血清miR-451a、MIF预测STEMI患者PCI术后并发HF的曲线下面积(AUC)分别为0.878、0.862,截断值分别为0.74、79.32 ng/ml,敏感度分别为79.4％、76.5％,特异度均为87.7％;两者联合预测STEMI患者PCI术后并发HF的AUC为0.938,敏感度为91.2％,特异度为86.8％.结论 PCI术后并发HF的STEMI患者血清miR-451a表达水平较低,与MIF呈显著负相关,且miR-451a、MIF联合检测可以更好地预测STEMI患者PCI术后并发HF.
Abstract
Objective To investigate the relationship between expression of serum microRNA-451a (miR-451a) and heart failure (HF) after intervention for acute myocardial infarction (AMI).Methods The patients with ST-segment elevation myocardial infarction (STEMI,n=140) undergone PCI were chosen from Rugao Hospital affiliated to Nantong University from Nov.2019 to Deb.2021.The patients were divided,according to HF occurrence after PCI,into non-HF group (n=106) and HF group (n=34).The clinical data and levels of serum miR-451a and macrophage migration inhibitory factor (MIF) were compared between 2 groups.The correlation between serum miR-451a and MIF was analyzed in patients with STEMI complicated by HF after PCI.The influence factors for HF occurrence after PCI were analyzed.The predictive value of miR-451a and MIF to complicated HF was analyzed in STEMI patients after PCI.Results The percentages of patients aged≥60,with diseased vessels≥2,diabetes,time from onset to PCI≥12 h,hypertension and hyperlipidemia,and MIF level were higher (P＜0.05),and percentages of patients with left ventricular ejection fraction (LVEF) ≥50％ and miR-451a expression were lower (P＜0.05) in HF group than those in non-HF group.The level of serum miR-451a was negatively correlated to MIF (r=-0.484,P＜0.05),and MiR-451a and LVEF were protective factors for HF in HF group after PCI (OR=0.553,0.679,P＜0.05).Age,time from onset to PCI,diabetes,number of diseased vessels,hyperlipidemia,hypertension and MIF were risk factors for HF after PCI (OR=2.208,2.187,2.572,2.394,2.456,2.630,2.781,P＜0.05).In prediction of HF by miR-451a and MIF,AUC was,respectively,0.878 and 0.862,cutoff value was,respectively,0.74 ng/ml and 79.32 ng/ml,sensitivity was,respectively,79.4％ and 76.5％,and both specificities were 87.7％.In prediction of HF by miR-451a combined with MIF,AUC was 0.938,sensitivity was 91.2％ and specificity was 86.8％.Conclusion The expression of serum miR-451a is lower in STEMI patients complicated by HF,which is negatively correlated to MIF significantly,and detection of MIF combined with miR-451a can predict HF better in STEMI after PCI.
维普
万方数据