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两种指标协同预测老年ST段抬高型心肌梗死患者心室重构的临床价值

Predictive value of combined two indicators for ventricular remodeling in elderly patients with ST-segment elevation myocardial infarction

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【作者】 曾德利邱曼王永宇

【Author】 Zeng Deli;Qiu Man;Wang Yongyu;Department of General Medicine,Qionghai People’s Hospital;

【机构】 琼海市人民医院全科医学科琼海市人民医院心内科

【摘要】 目的 探讨血清微小RNA(micorRNA,miR)-34a联合N末端B型钠尿肽前体(NT-proBNP)协同预测老年ST段抬高型心肌梗死(STEMI)患者心室重构的临床价值。方法 选择2018年6月至2020年3月琼海市人民医院心内科诊治的老年STEMI患者224例,根据左心室舒张末期容积(LVEDV)较基线值变化ΔLVEDV分为心室重构组64例和非心室重构组160例。行PCI术后3 d内和随访6个月后进行心脏磁共振成像,计算6个月以后LVEDV、左心室收缩末期容积(LVESV)较基线值变化ΔLVEDV、ΔLVESV。使用实时荧光定量聚合酶链反应法检测入院时血清样本中miR-34a表达。结果 随访6个月,224例患者中发生心室重构64例(28.6%)。心室重构组NT-proBNP、miR-34a水平明显高于非心室重构组,差异有统计学意义(P<0.01)。Pearson相关性分析显示,心室重构组血清miR-34a表达与ΔLVEDV、ΔLVESV呈正相关(r=0.611,P=0.001;r=0.268,P=0.016)。多因素logistic回归分析显示,NT-proBNP、miR-34a、梗死面积、微血管阻塞是影响老年STEMI患者PCI术后6个月心室重构发生风险的独立影响因素(OR=4.735,95%CI:1.622~13.065,P=0.001;OR=6.022,95%CI:2.817~17.925,P=0.001;OR=1.318,95%CI:1.022~1.701,P=0.015;OR=1.369,95%CI:1.007~3.144,P=0.008)。ROC曲线分析显示,miR-34a+NT-proBNP联合预测心室重构的曲线下面积明显高于NT-proBNP单独预测(P<0.05)。结论 入院时血清miR-34a水平是老年STEMI患者早期PCI术后发生心室重构的一个独立预测因素,而且可以提高NT-proBNP预测心室重构的准确性。

【Abstract】 Objective To investigate the clinical value of serum microRNA-34a(miR-34a) combined with N-terminal pro-B-type natriuretic peptide(NT-proBNP) in predicting ventricular remodeling in elderly patients with ST-elevation myocardial infarction(STEMI).Methods A total of 224 elderly STEMI patients admitted in our hospital from June 2018 to March 2020 were recruited, and then divided into ventricular remodeling group(64 cases) and non-ventricular remodeling group(160 cases) according to whether the change(ΔLVEDV) of left ventricular end-diastolic volume ≥10%.Cardiac magnetic resonance imaging was performed 3 d after PCI and in the end of 6 months’ follow-up.The ΔLVEDV and change(ΔLVESV) of left ventricular end-systolic volume index between baseline and 6 months after PCI were calculated.Results In 6 months of follow-up, 64 patients(28.6%) of the 224 subjects showed adverse ventricular remodeling.The baseline levels of serum NT-proBNP and miR-34a were significantly higher in the patients from the ventricular remodeling group than those of the non-ventricular remodeling group(P<0.01).Pearson correlation analysis indicated that the serum miR-34a expression was correlated with ΔLVEDV and ΔLVESV values in the patients with ventricular remodeling(r=0.611,P=0.001;r=0.268,P=0.016).Multivariate logistic regression analysis showed that NT-proBNP,miR-34a, infarct size and microvascular occlusion were independent risk factors for ventricular remodeling in elderly STEMI patients 6 months after PCI(OR=4.735,95%CI:1.622-13.065,P=0.001;OR=6.022,95%CI:2.817-17.925,P=0.001;OR=1.318,95%CI:1.022-1.701,P=0.015;OR=1.369,95%CI:1.007-3.144,P=0.008).ROC curve analysis showed that the AUC value of combined miR-34a and NT-proBNP in predicting the ventricular remodeling was obviously higher than that of NT-proBNP alone(P<0.05).Conclusion Serum miRr-34a at admission is an independent predictor of ventricular remodeling in elderly STEMI patients after PCI,and can improve the accuracy of NT-proBNP in prediction of ventricular remodeling.

【基金】 海南省卫生计生行业科研项目(18A200156)
  • 【文献出处】 中华老年心脑血管病杂志 ,Chinese Journal of Geriatric Heart Brain and Vessel Diseases , 编辑部邮箱 ,2023年09期
  • 【分类号】R542.22
  • 【下载频次】21
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