COPD 患者血清microRNA-210、HIF-1α 水平 与心率变异性及肺功能的相关性

Relationship of both serum miR-210 and hif-1 alpha levels with heart rate variability and lung function in patients with COPD

摘要:

目的 分析慢性阻塞性肺疾病（COPD）患者血清microRNA-210（miR-210）、HIF-1α 水 平与心率变异性及肺功能指标的关系。方法 选取2016 年12 月—2017 年12 月张家口市第一医院收治的 COPD 患者120 例。按照COPD 分级标准，将患者分为轻度组35 例、中度组45 例和重度组40 例，择取同 期健康体检者35 例作为对照组。比较急性加重期与稳定期COPD 患者的血清miR-210、HIF-1α 水平及 肺功能指标；比较不同严重程度分级COPD 患者的心率变异性和肺功能指标；分析心率变异性与肺功能的 相关性。结果 急性加重期COPD 患者血清miR-210、HIF-1α 水平和第1 秒用力呼气量/ 用力肺活量 （FEV1/FVC）低于稳定期（P <0.05）；而FEV1 比较，差异无统计学意义（P >0.05）。急性加重期COPD 患者 血清miR-210 与HIF-1α 水平呈正相关（r =0.364，P =0.000），而与FEV1 和FEV1/FVC 呈负相关（r =-0.375 和-0.287，P =0.030 和0.002）。稳定期COPD 患者血清miR-210 与HIF-1α 水平呈正相关（r =0.214， P =0.025），而与FEV1/FVC 呈负相关（r =-0.345，P =0.008）。轻度组、中度组和重度组窦性RR 间期标准 差（SDNN）、窦性RR 期间均值的标准差（SDANN）、全部相邻窦性RR 期间差值的均方根值（rMSSD）、 >50 ms 间隔邻近周期的比例（pNN50）、高频值（HF）及低频值（LF）心率变异性较对照组升高（P <0.05）， 中度组和重度组低于轻度组（P <0.05），重度组低于中度组（P <0.05）。轻度组、中度组和重度组FVC、 FEV1、FEV1/FVC 及呼气流量峰值（PEF）较对照组降低（P <0.05），轻度组和中度组高于重度组（P <0.05）， 轻度组高于中度组（P <0.05）。COPD 患者FVC 与SDNN、SDANN、rMSSD、pNN50、HF 及LF 呈正 相关（r =0.734、0.762、0.758、0.773、0.765 和0.774， 均P =0.000），FEV1 与SDNN、SDANN、rMSSD、 pNN50、HF 及LF 呈正相关（r =0.782、0.792、0.781、0.794、0.801 和0.784， 均P =0.000），FEV1/FVC 与 SDNN、SDANN、rMSSD、pNN50、HF 及LF 呈正相关（r =0.784、0.792、0.784、0.791、0.812 和0.783， 均P =0.000），PEF 与SDNN、SDANN、r-MSSD、pNN50、HF 及LF 呈正相关（r =0.764、0.785、0.773、 0.781、0.775 和0.783，均P =0.000）。Pearson 相关性分析结果显示，随着患者SDANN、rMSSD、SDNN、 pNN50、HF 及LF 心率变异性的升高，FVC、FEV1、FEV1/FVC 及PEF 亦同时升高。结论 COPD 患者血清 miR-210、HIF-1α 水平与心率变异性、肺功能有相关性，一定程度上可反映病情的严重程度；心率变异性 与肺功能也存在相关性，可用于病情的预测。

Abstract:

Objective To analyze the relationship of both serum miR-210 and HIF-1 alpha levels with heart rate variability and lung function in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 120 patients with chronic obstructive pulmonary disease (COPD) admitted to our department from December 31, 2016 to January 1, 2017 were collected from venous blood during the stable phase and acute exacerbation phase of the disease, and the serum miR-210 and hif-1 alpha levels were detected. According to the classification of COPD, patients were divided into the mild group of 35 cases, the moderate group of 45 cases, and the severe group of 40 cases. The serum miR-210 and hif-1 alpha levels were compared with lung function indicators in 35 healthy subjects as control group. Comparison of pulmonary function parameters in acute exacerbation stage of copd; Comparison of heart rate variability among the four groups; Comparison of lung function among four groups; Relationship between heart rate variability and lung function. Results serum miR-210, HIF-1 alpha, and FEV1 /FVC levels in patients with acute exacerbation of copd were significantly lower than those in the stationary phase (P < 0.05). FEV1 had no significant change during the period of acute exacerbation (P > 0.05). Serum miR-210 was positively correlated with hif-1 alpha level in patients with acute exacerbation (r = 0.364, P < 0.05), and negatively correlated with FEV1 and FEV1/FVC (r = -0.375 and -0.287, both P < 0.05). Serum miR-210 was positively correlated with hif-1 alpha (r = 0.214, P < 0.05) and negatively correlated with FEV1/FVC in patients with stable stage (r = -0.345, P < 0.05). SDANN, r-mssd, SDNN, pNN50, HF and LF in the mild, moderate and severe groups were significantly increased compared with the control group (P < 0.05). The index of heart rate variability in the moderate group and the severe group was lower than that in the mild group (P < 0.05). The index of heart rate variability in the severe group was lower than that in the moderate group (P < 0.05). Compared with the control group, FVC, FEV1, FEV1/FVC, PEF and other indicators of lung function in the mild, moderate and severe groups were significantly reduced (P < 0.05). The indexes of pulmonary function in mild group and moderate group were significantly higher than those in severe group (P < 0.05). The index of pulmonary function in the mild group was significantly higher than that in the moderate group (P < 0.05). FVC was positively correlated with SDNN, SDANN, r-MSSD, pNN50, HF and LF in patients with copd (r = 0.734, 0.762, 0.758, 0.773, 0.765, 0.774, all P < 0.05). FEV1 was positively correlated with SDNN, SDANN, r-MSSD, pNN50, HF and LF (r = 0.782, 0.792, 0.781, 0.794, 0.801, all P < 0.05), FEV1/FVC was positively correlated with SDNN, SDANN, r-MSSD, pNN50, HF and LF (r = 0.784, 0.792, 0.784, 0.791, 0.812 and 0.783, P < 0.05). PEF as positively correlated with SDNN, SDANN, r-MSSD, pNN50, HF and LF(r = 0.764, 0.785, 0.773, 0.781, 0.775 and 0.783, all P < 0.05). Pearson correlation analysis results showed that with the increase of variation indicators such as SDANN, r-mssd, SDNN, pNN50, HF and LF, FVC, FEV1, FEV1/FVC, PEF and other pulmonary function indicators. Conclusion Serum miR-210 and HIF-1 alpha levels of COPD patients are correlated with heart rate variability and lung function, which can reflect the severity of the disease to some extent, and heart rate variability is also correlated with lung function, which can be used to predict the disease.