慢性心力衰竭患者血清微小核糖核酸-29b表达水平及其临床意义OACSTPCD

Objective To investigate the expression level of microRNA-29b(miR-29b)in the serum of patients with chronic heart failure(CHF)and its clinical significance.Methods A total of 167 CHF patients admitted to the Fourth Hospital of Changsha from June 2017 to August 2020 were selected as the observation group,and they were classified according to the New York Heart Association(NYHA)classification criteria.A total of 145 healthy individuals undergoing physical examinations during the same period were selected as the control group.Quantitative real-time polymerase chain reaction(qRT-PCR)was used to detect serum expression of miR-29b.Left atrial diameter(LAD),left ventricular remodelling index(LVRI),left ventricular end diastolic diameter(LVEDD),left ventricular posterior wall depth(LVPWD)and left ventricular mass index(LVMI),left ventricular ejection fraction(LVEF),and cardiac output(CO)were measured by echocardiography.Serum levels of N-terminal pro brain natriuretic peptide(NT-proBNP),cardiac troponin I(cTnI),and cardiac troponin T(cTnT)were measured,and the Kansas City Cardiomyopathy Questionnaire(KCCQ)score and 6 min walk test(6MWT)were assessed.The above indicators between the control group and the patients with different functional grades in the observation group were compared.The relationship between serum miR-29b expression level and cardiac function,ventricular remodeling index,and quality of life in the observation group was analyzed by Pearson correlation analysis.A one-year follow-up was conducted,and the relationship between serum miR-29b expression level and prognosis in CHF patients was analyzed by multivariate Logistic regression.Results In the observation group,the relative expression levels of serum miR-29b,LVRI,CO,LVEF,KCCQ scores,and 6MWT all decreased gradually in NYHA gradeⅡ,Ⅲand Ⅳpatients(P<0.05),and were all lower than those in the control group(F=831.833,386.491,110.251,71.503,101.552,867.632;P<0.05).The LAD,LVEDD,LVMI,LVPWD,and the levels of serum NT-proBNP,cTnI,cTnT all increased successively in gradeⅡ,Ⅲ and Ⅳ patients in the observation group(P<0.05),and were all higher than those in the control group(F=238.758,528.524,241.700,58.167,3 712.854,1 836.663,2 230.468;P<0.05).Pearson correlation analysis showed that miR-29b expression was negatively correlated with LVEDD,LVPWD,LVMI,LAD,serum NT-proBNP,cTnI,and cTnT levels in CHF patients(r=-0.822,-0.884,-0.891,-0.713,-0.854,-0.813,-0.832;P<0.05),while it was positively correlated with LVEF,CO,LVRI and KCCQ scores,and 6MWT(r=0.734,0.864,0.791,0.721,0.783;P<0.05).Multivariate Logistic regression analysis showed that the expression of serum miR-29b was a protective factor for poor prognosis in CHF patients(OR=0.517,P<0.05),while NYHA gradeⅢ/Ⅳ and poor compliance with medical orders were the risk factors for poor prognosis(OR=5.496,6.074;P<0.05).Conclusion miR-29b expression is an influencing factor for poor prognosis in CHF patients,which plays an important guiding role in the clinical diagnosis and treatment of CHF.