摘要
目的探讨血清B型利尿钠肽(BNP)、微RNA-132(miR-132)与慢性阻塞性肺疾病急性加重期(AECOPD)患者并发心力衰竭的剂量-反应关系。方法选取2021年1月至2024年12月山西医科大学附属运城市中心医院收治的205例AECOPD患者,根据住院期间是否并发心力衰竭分为发生组和未发生组。应用倾向评分匹配两组基线协变量,匹配后两组分别纳入70例患者。比较匹配后两组患者的血清BNP、miR-132水平,应用logistic回归方程和限制性立方样条模型(RCS)分析血清BNP、miR-132水平与AECOPD患者并发心力衰竭的相关性,应用受试者操作特征(ROC)曲线分析血清BNP、miR-132水平对AECOPD患者并发心力衰竭的预测效能。结果发生组第一秒用力呼气容积占预计值百分比(FEV_(1)%)、第一秒用力呼气容积占用力肺活量百分比(FEV_(1)/FVC)及miR-132水平低于未发生组,急性生理与慢性健康状况评价Ⅱ(APACHEⅡ)评分、BNP水平高于未发生组,差异有统计学意义(P<0.05);校正FEV_(1)%、FEV_(1)/FVC、APACHEⅡ评分后,BNP、miR-132仍是AECOPD患者并发心力衰竭的影响因素(P<0.05);心力衰竭与BNP呈线性相关,与miR-132呈非线性相关(P<0.05);BNP联合miR-132对AECOPD患者并发心力衰竭的预测效能高于FEV_(1)%、FEV_(1)/FVC及APACHEⅡ评分联合应用(AUC分别为0.926、0.849;P<0.05)。结论血清BNP、miR-132与AECOPD患者并发心力衰竭密切相关,联合检测可提高对心力衰竭的预测效能,有助于临床识别高危人群,采取合理诊治措施。
Objective To investigate the dose-response relationship between serum B-type natriuretic peptide(BNP),microRNA-132(miR-132),and heart failure in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Method A total of 205 patients with AECOPD in Yuncheng Central Hospital Affi liated to Shanxi Medical University from January 2021 to December 2024 were selected and divided into an occurrence group and a non-occurrence group based on whether heart failure occurred during their hospitalization.Propensity score matching(PSM)was applied to match the baseline covariates of the two groups.The levels of serum BNP and miR-132 were compared between the two groups after PSM.Logistic regression equations and restricted cubic spline models(RCS)were used to analyze the relationship between serum BNP,miR-132 levels,and heart failure in patients with AECOPD.Receiver operating characteristic(ROC)curves were used to analyze the predictive value of serum BNP and miR-132 levels for heart failure in patients with AECOPD.Result After PSM,the levels of FEV_(1)%,FEV_(1)/FVC and miR-132 in the occurrence group were lower than those in the non-occurrence group,and the APACHEⅡscore and BNP level were higher than those in the non-occurrence group(P<0.05).After adjusting for FEV_(1)%,FEV_(1)/FVC,and APACHEⅡscores,BNP and miR-132 remained as influencing factors for AECOPD patients with concurrent heart failure(P<0.05).Heart failure was linearly correlated with BNP and non-linearly correlated with miR-132(P<0.05).The value of BNP+miR-132 in predicting heart failure was higher than that of FEV_(1)%+FEV_(1)/FVC+APACHEⅡscores(AUC:0.926 vs 0.849;P<0.05).Conclusion Serum BNP and miR-132 are closely related to the development of heart failure in patients with AECOPD.Combined detection can enhance the predictive effi cacy of heart failure,assisting clinicians in identifying high-risk populations and adopting appropriate diagnostic and treatment measures.
作者
王银娟
付英
昌敏
Wang Yinjuan;Fu Ying;Chang Min(Department of Respiratory and Critical Care Medicine,Yuncheng Central Hospital Affiliated to Shanxi Medical University,Yuncheng,Shanxi 044000,China)
出处
《中国医刊》
2026年第2期146-150,共5页
Chinese Journal of Medicine
基金
山西省卫生健康委科研课题(2022710)。
