免疫调控因子IL-21与miR-499在扩张型心肌病合并房颤患者左心房重构中表达及相关性

    Expression and relationship of immunoregulatory factors IL-21 and miR-499 in left atrial remodeling in patients with dilated cardiomyopathy complicated with atrial fibrillation

      摘要
    • 摘要:
      目的 探究miR-499与IL-21在扩张型心肌病合并房颤患者血清中的表达及其相关性。
      方法 选取南京医科大学附属淮安一院2018年1月～2023年1月收治的扩张型心肌病患者79例，其中合并房颤者31例，非房颤患者48例，分析比较两组患者的左房内径；使用RT-PCR及ELISA分析miR-499、IL-21以及血清纤维化因子Ⅲ型前胶原氨基末端肽(type III procollagen amino terminal peptide, PIIINP)、基质金属蛋白酶-2 (matrix metalloproteinase-2, MMP -2)的外周表达量，采用Pearson分析IL-21与miR-499等因素之间的相关性，采用Logistics回归分析房颤发生的危险因素。
      结果 与非房颤组组患者比较，房颤组年龄大（P<0.01）、病程长(P<0.05)、肺动脉压增高比例大（P<0.01），左心室射血分数降低（P<0.05）、左室收缩末内径增加（P<0.01）、左房前后径增大（P<0.05）、尿酸值增高（P<0.01）。合并房颤患者外周血的miR-499（P<0.05）、IL-21（P<0.01）、PIIINP（P<0.05）、MMP-2（P<0.01）及含量均高于非房颤组。Pearson相关分析显示IL-21与左房内径、PIIINP、MMP-2及miR-499之间存在正性相关性（均P<0.05）。多因素Logistic回归分析显示年龄、病程、血清甘油三酯、尿酸值、左心室射血分数、左室收缩末内径、左房内径、肺动脉高压为扩张型心脏病合并房颤发生的独立危险因素。
      结论 免疫因子IL-21及血清miR-499的异常表达与扩张型心肌病并发房颤者左心房纤维化之间存在密切关系，年龄等8项指标为扩张型心脏病合并房颤发生的独立危险因素。

       

      Abstract:
      AIM To investigate the expressions and clinical value of miR-499 and IL-21 in the serum of patients with dilated cardiomyopathy complicated with atrial fibrillation.
      METHODS 79 patients with dilated cardiomyopathy admitted to Huai'an First Affiliated Hospital of Nanjing Medical University from January 2018 to January 2023 were selected, including 31 patients with concomitant atrial fibrillation and 48 patients without atrial fibrillation. The left atrial diameter of the two groups of patients was analyzed and compared; RT-PCR and ELISA were used to analyze the peripheral expression levels of miR-499, IL-21, and serum fibrosis factors type III procollagen amino terminal peptide (PIIINP), matrix metalloproteinase-2 (MMP-2). Pearson analysis was used to examine the correlation between IL-21 and miR-499, and logistic regression was used to analyze the risk factors for atrial fibrillation.
      RESULTS Compared with the non atrial fibrillation group, the atrial fibrillation group had older age (P<0.01), longer disease course (P<0.05), higher proportion of pulmonary artery pressure (P<0.01), lower left ventricular ejection fraction (P<0.05), increased left ventricular end systolic diameter (P<0.01), increased left atrial anterior posterior diameter (P<0.05), and higher uric acid value (P<0.01). The peripheral blood levels of miR-499 (P<0.05), IL-21 (P<0.01), PIIINP (P<0.05), MMP-2 (P<0.01), and their levels in patients with concomitant atrial fibrillation were higher than those in the non atrial fibrillation group. Pearson correlation analysis showed a positive correlation between IL-21 and left atrial diameter, PIIINP, MMP-2, and miR-499 (all P<0.05). Multivariate logistic regression analysis showed that age, course of disease, serum triglycerides, uric acid value, left ventricular ejection fraction, left ventricular end systolic diameter, left atrial diameter, and pulmonary hypertension were independent risk factors for the occurrence of dilated heart disease with atrial fibrillation.
      CONCLUSION The abnormal expression of immune factor IL-21 and serum miR-499 is closely related to left atrial fibrosis in patients with dilated cardiomyopathy complicated with atrial fibrillation. Age and other seven indicators are independent risk factors for the occurrence of dilated cardiomyopathy complicated with atrial fibrillation.

       

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