摘要
目的：探讨急性心肌梗死（AMI）患者血浆miRNA-423-5p水平与心肌梗死后心室重构严重程度的关系及对AMI患者临床预后的影响。方法选择2012年6月至2014年6月在我院心内科住院并诊断为急性ST段抬高型心肌梗死（ STEMI）患者248例，根据入院血浆miRNA-423-5p水平的三分位数间距将患者分为低水平组（miRNA-423-5p＜0.35）80例，中水平组（0.36≤miRNA-423-5p≤0.72）86例和高水平组（miRNA-423-5p＞0.72）82例。测定患者入院即刻N末端脑钠肽前体（NT-proBNP）水平，并于入院7～10 d内及半年后行超声心动图测定患者左室舒张末期内径（ LVEDd）、左室舒张末期容积（ LVEDV）、左室收缩末期容积（ LVESV）、左室射血分数（ LVEF）。动态追踪观察三组患者随访期间（6个月内）心脏不良事件（ MACE）的发生情况。结果三组患者随miRNA-423-5p水平升高， NT-proBNP 水平升高，术后半年的 LVEDV 和 LVESV 显著增加， LVEF 降低[（1075.33±98.54） pg／L比（832.17±86.55） pg／L比（552.66±68.58） pg／L；（132.35±11.56） ml比（130.66±12.25） ml比（127.51±10.35） ml；（61.86±11.53） ml比（59.92±10.25） ml比（59.02±11.23） ml；47.05％±4.16％比48.14％±3.78％比49.82％±4.53％，均为P＜0.05]，STEMI患者miRNA-423-5p与NT-proBNP水平呈正相关（r＝0.412，P＜0.05）。直接PCI术后随访6个月，Kaplan？Meier生存分析发现三组患者累积无MACE事件生存率差异有统计学意义（96.25％比90.70％比81.71％，Log rank＝9.605，P＝0.008），多因素Logistic回归分析显示miRNA-423-5p、NT-proBNP均为STEMI患者近期MACE发生的独立预测因子。结论 AMI患者入院血浆miRNA-423-5p水平与心肌梗死后心室重构密切相关，并对AMI患者的近期预后具有预测意义。
Objective To investigate the relationship between miRNA-423-5p and left ventricular remodeling in patients with acute myocardial infarction, and the predictive values of miRNA-423-5p for patients′prognosis. Methods A total of 248 patients with STEMI who underwent primary percutaneous coronary intervention （ PCI） from June 2012 to June 2014 in our department of cardiology were enrolled and followed up. Patients were divided into three groups according to the plasma miRNA-423-5p levels on admission：low-level group （miRNA-423-5p＆lt;0. 35） including 80 cases;mid-level group （0. 36≤miRNA-423-5p≤0. 72） including 86 cases and high-level group （miRNA-423-5p＆gt;0. 72） including 82 cases. NT-proBNP of patients on admission was measured,and patients accept echocardiography examination 7-10 days and 6 months after PCI. Major cardiac adverse events （ MACE） of patients in three groups during follow-up were recorded. Results Compared with low-level group,patients in mid-level or high-level group had higher NT-proBNP levels,worse indicators of left ventricular remodeling and lower LVEF 6 months after PCI. After 6 months of follow-up,Kaplan？Meier survival analysis showed patients in three groups had significantly different cumulative non-events survival rates （ 96. 25% vs. 90. 70% vs. 81. 71%, Log rank =9. 605, P =0. 008）. Binary Logistic regression analysis showed that both miRNA-423-5p and NT-proBNP were strong independent predictors of recent prognosis in STEMI patients. Conclusions MiRNA-423-5p is associated with left ventricular remodeling in patients with AMI and is valuable in predicting recent prognosis of AMI patients.
出处
《中国心血管杂志》
2016年第4期273-277,共5页
Chinese Journal of Cardiovascular Medicine
基金
广州市科技计划项目(2012Y2-00025)~~
关键词
心肌梗死
心室重构
miRNA-423-5p
miRNA-423-5p
Myocardial infarction
Ventricular remodeling
