【摘要】 背景左心室肥厚是高血压导致的常见靶器官损伤,血小板的黏附、聚集及细胞因子释放在其发生、发展过程中发挥着重要作用,且大体积常较小体积的血小板代谢更为活跃。此外,微小RNA(miRNA)作为各种细胞活动的强大调节剂,包括细胞的生长、分化、发育及凋亡,同样在心肌重构、增殖及分化过程中具有重要的调控作用。然而目前关于平均血小板体积与血小板计数比值(MPV/PLT)、miRNA-26b相对表达量、miRNA-195相对表达量在高血压性左心室肥厚诊断中的相关报道较少。目的探讨MPV/PLT、miRNA-26b相对表达量、miRNA-195相对表达量与高血压性左心室肥厚的关系及其对患者预后的预测价值。方法选取2017年4月—2019年12月唐山市人民医院收治的高血压性左心室肥厚患者102例,根据左心室心肌质量指数(LVMI)分为低LVMI组(≤110 g/m~2)52例和高LVMI组(> 110 g/m~2)50例。比较两组患者临床资料、miRNA-26b相对表达量、miRNA-195相对表达量、预后及不同预后患者的临床资料、miRNA-26b相对表达量、miRNA-195相对表达量;采用多元线性回归分析探讨高血压性左心室肥厚患者LVMI的影响因素,并采用多因素Logistic回归分析探讨高血压性左心室肥厚患者预后的影响因素;绘制受试者工作特征曲线(ROC曲线)分析LVMI、MPV/PLT、miRNA-26b相对表达量、miRNA-195相对表达量及其联合对高血压性左心室肥厚患者预后的预测价值。结果高LVMI组患者24 h动态收缩压、24 h动态脉压、左心室心肌质量(LVM)、miRNA-195相对表达量高于低LVMI组,MPV/PLT、miRNA-26b相对表达量低于低LVMI组,预后良好发生率低于低LVMI组(P <0.05)。多元线性回归分析结果显示:LVM、MPV/PLT、miRNA-26b相对表达量、miRNA-195相对表达量是高血压性左心室肥厚患者LVMI的独立影响因素(P <0.05)。预后不良的高血压性左心室肥厚患者LVMI、miRNA-195相对表达量高于预后良好者,MPV/PLT、miRNA-26b相对表达量低于预后良好者(P <0.05)。多因素Logistic回归分析结果显示:24 h动态收缩压、24 h动态脉压、LVM、LVMI、MPV/PLT、miRNA-26b相对表达量及miRNA-195相对表达量是高血压性左心室肥厚患者预后的影响因素(P <0.05)。ROC曲线分析结果显示,LVMI、MPV/PLT、miRNA-26b相对表达量、miRNA-195相对表达量联合预测高血压性左心室肥厚患者预后的曲线下面积(AUC)大于各指标单独预测(P值均<0.001)。结论 LVM、MPV/PLT、miRNA-26b相对表达量、miRNA-195相对表达量是高血压性左心室肥厚的独立影响因素,且LVMI、MPV/PLT、miRNA-26b相对表达量、miRNA-195相对表达量联合对高血压性左心室肥厚患者预后具有较高的预测价值。更多还原

【Abstract】 Background Left ventricular hypertrophy is a common target organ damage caused by hypertension.Platelet adhesion,aggregation and cytokine release play an important role in the development of left ventricular hypertrophy.The metabolism of large-volume platelets are more active than small-volume platelets.In addition,microRNAs(miRNAs) play an important role in the process of myocardial remodeling,proliferation and differentiation.However,there are few reports on the predicative values of mean platelet volume/platelet count(MPV/PLT),miRNA-26b relative expression level,miRNA-195 relative expression level in the diagnosis of patients with hypertensive left ventricular hypertrophy.Objective To explore the association between MPV/PLT,miRNA-26b relative expression level,miRNA-195 relative expression level and hypertensive left ventricular hypertrophy and their predictive value on patients’ prognosis.Methods From April 2017 to December 2019,102 cases of patients with hypertensive left ventricular hypertrophy admitted to Tangshan People’s Hospital were included.Fifty-two cases were in low ventricular myocardial mass index(LVMI) group( ≤ 110 g/m~2) and 50 cases in high LVMI group(> 110 g/m~2) according to the LVMI. Clinical data,miRNA-26b relative expression level,miRNA-195 relative expression level and the outcomes of the patients were compared between the two groups.Clinical data,miRNA-26b relative expression level,miRNA-195 relative expression level were compared in patients with hypertensive left ventricular hypertrophy in different prognosis.Multiple linear regression analysis was used to explore the risk factors of LVMI in patients with hypertensive left ventricular hypertrophy.Multiple Logistic regression analysis was used to analyze the influencing factors of prognosis of patients with hypertensive left ventricular hypertrophy.Receiver operating characteristic curve(ROC curve) was drawn to analyze the predictive value of LVMI,MPV/PLT,miRNA-26b relative expression level,miRNA-195 relative expression level and their combination on prognosis of patients with hypertensive left ventricular hypertrophy.Results 24 h dynamic systolic blood pressure,24 h dynamic pulse pressure,left ventricular myocardial mass(LVM),miRNA-195 relative expression level in the high LVMI group were higher than those in the low LVMI group,MPV/PLT and miRNA-26b relative expression level in the high LVMI group were lower than those in the low LVMI group,and the incidence of good prognosis in the high LVMI group was lower than that in the low LVMI group(P <0.05).Multiple linear regression analysis showed that LVM,MPV/PLT,miRNA-26b relative expression level,and miRNA-195 relative expression level were independent risk factors of LVMI in patients with hypertensive left ventricular hypertrophy(P <0.05).LVMI and miRNA-195 relative expression level in the poor prognosis patients with hypertensive left ventricular hypertrophy were higher than those with good prognosis,while MPV/PLT and miRNA-26b relative expression level were lower than those with good prognosis(P <0.05).Multiple Logistic regression analysis showed that 24 h dynamic systolic blood pressure,24 h dynamic pulse pressure,LVM,LVMI,MPV/PLT,miRNA-26b relative expression level and miRNA-195 relative expression level were independent influencing factors of prognosis in patients with hypertensive left ventricular hypertrophy(P <0.05).ROC curve analysis showed that the area under the curve(AUC) of combination of LVMI,MPV/PLT,miRNA-26b relative expression level and miRNA-195 relative expression level was lager than each index tested separately in predicting the prognosis of patients with hypertensive left ventricular hypertrophy(P <0.001).Conclusion LVM,MPV/PLT,miRNA-26b relative expression level,and miRNA-195 relative expression level are independent risk factors of hypertensive left ventricular hypertrophy.Meanwhile,the combination of LVMI,MPV/PLT,miRNA-26b relative expression level,and miRNA-195 relative expression level has higher predictive value for prognosis of patients with hypertensive left ventricular hypertrophy.更多还原