血浆miR-21与心房颤动射频消融术后复发的关系研究

目的 研究心房颤动患者血浆miR-21、miR-133、miR-328水平,探讨其与心房颤动射频消融术后复发的相关性。 方法 选择2016年9月—2018年9月首都医科大学附属北京安贞医院、平煤神马集团总医院、山东大学第二医院、青岛大学附属医院收治的500例心房颤动患者为研究对象,以同期在北京安贞医院体检的200例健康体检者作为对照组。抽取空腹静脉血检测miR-21、miR-133、miR-328的水平,所有房颤患者均进行射频消融术治疗,术后口服普罗帕酮150 mg,3次/d,服用1个月,随访1年,比较复发组与未复发组患者microRNA表达水平,分析microRNA预测心房颤动复发的效能。 结果 500例心房颤动患者术后复发136例(27.2%)。3组患者基线资料间比较差异无统计学意义(均P<0.05)。复发组和未复发组miR-21、miR-328表达量高于对照组,而miR-133则低于对照组(均P<0.05),但复发组与未复发组比较仅有miR-21差异有统计学意义(P<0.05)。预测房颤复发的ROC曲线图显示,miR-21 cut-off值=1.995诊断效率最高,其敏感度、特异度、约登指数及AUC分别为77.21%、83.79%、0.610及0.876。 结论 血浆miR-21表达量显著升高对预测心房颤动射频消融术后复发有一定的参考价值,可作为指导临床治疗的一项依据。 

Study on the relationship between plasma miR-21 and recurrence of atrial fibrillation after radiofrequency ablation

Objective To investigate plasma levels of miR-21, miR-133, miR-328 in patients with atrial fibrillation, and explore their correlation with the recurrence of atrial fibrillation after radiofrequency ablation. Methods Total 500 patients with atrial fibrillation admitted to Beijing Anzhen Hospital Affiliated to Capital Medical University, General Hospital of Shenma Group, the Second Hospital of Shandong University and the Affiliated Hospital of Qingdao University from September 2016 to September 2018 were selected as the study objects, and 200 healthy patients who underwent physical examination in Beijing Anzhen hospital during the same period were selected as the control group. Fasting venous blood was extracted to detect the levels of miR-21, miR-133 and miR-328. All patients with atrial fibrillation were treated with radiofrequency ablation. After the operation, oral propafenon 150 mg was taken 3 times/d for 1 month, and the patients were followed up for 1 year. MicroRNA expression levels of patients in recurrent group and the non-recurrent group were compared, and the effect of microRNA in predicting the recurrence of atrial fibrillation was analyzed. Results Postoperative recurrence occurred in 136 of the 500 patients with atrial fibrillation(27.2%). There was no significant difference in baseline data among the three groups(all P<0.05).The expressions of miR-21 and miR-328 in the recurrent group and the non-recurrent group were higher than those in the control group, while the expressions of miR-133 were lower than those in the control group(all P<0.05). However, only miR-21 in the recurrence group and the non-recurrence group showed statistical significance(P<0.05).The ROC curve for predicting the recurrence of atrial fibrillation showed that miR-21 cut-off value(1.995) had the highest diagnostic efficiency, with sensitivity, specificity, Youden index and AUC of 77.21%, 83.79%, 0.610 and 0.876, respectively. Conclusion The significantly increased expression of miR-21 in plasma is of certain reference value for predicting the recurrence of atrial fibrillation after radiofrequency ablation, it can be used as a basis for guiding clinical treatment.