长链非编码RNA X非活性特异性转录物(XIST)在心房颤动患者中的表达与临床意义

Expression and Clinical Significance of Long Non-Coding RNA X Inactive Specific Transcript (XIST) in Patients with Atrial Fibrillation

摘要: 目的：研究长链非编码RNA X非活性特异性转录物(XIST)在心房颤动(AF)患者中的表达特征与临床意义。方法：选取2021年6月至2022年5月在山东第一医科大学第一附属医院心内科治疗的75例AF患者，并选取同期75例体检窦性心律者作为健康对照者。采集清晨空腹静脉血并分离血清，通过实时荧光定量PCR检测XIST表达水平。采用t和F检验分析XIST表达与年龄、性别、慢性病(糖尿病、高血压及冠心病)患病情况、AF类型(阵发性、持续性及永久性)、AF评分(CHA2DS2-VASc评分)及心功能分级(I、II、III及IV)之间的关系。采用Spearman检验分析XIST表达与左心室射血分数(LVEF)和左心房内径(LAD)的相关性。采用受试者工作特征(ROC)曲线分析XIST表达检测AF的诊断价值。结果：AF患者血清中XIST表达水平低于健康对照者(P < 0.05)。持续性和永久性AF患者血清中XIST表达水平低于阵发性AF患者(P < 0.05)。CHA2DS2-VASc评分 ≥ 2的AF患者血清中XIST表达水平低于CHA2DS2-VASc评分 < 2的AF患者(P < 0.05)。心功能III~IV级AF患者血清中XIST表达水平低于心功能I~II级AF患者(P < 0.05)。XIST表达与LVEF呈正相关(r = 0.48, P < 0.05)，而与LAD负相关(r = −0.73, P < 0.05)。XIST表达诊断AF、阵发性AF、持续性AF及永久性AF的曲线下面积分别为0.66、0.69、0.77及0.82 (P < 0.05)。结论：AF患者血清中XIST表达水平下调，与AF类型、CHA2DS2-VASc评分、心功能分级、LVEF及LAD相关。XIST表达对协助AF诊断具有一定的作用。

Abstract: Objective: To investigate the expression characteristic and clinical significance of long non-coding RNA X inactive specific transcript (XIST) in patients with atrial fibrillation (AF). Methods: Seven-ty-five patients with AF treated in the Department of Cardiology of the First Affiliated Hospital of Shandong First Medical University from June 2021 to May 2022 were selected, and 75 individuals with sinus rhythm on physical examination during the same period were selected as healthy con-trols. Early morning fasting venous blood was collected and serum was isolated, and the expression levels of XIST were detected by real-time fluorescence quantitative PCR. The associations between XIST expression and age, gender, chronic diseases (diabetes, hypertension and coronary artery disease), AF type (paroxysmal, persistent and permanent), AF score (CHA2DS2-VASc score) and car-diac function class (I, II, III and IV) were analyzed by the t and F test. The correlations between XIST expression and left ventricular ejection fraction (LVEF) and left atrial internal diameter (LAD) were analyzed by Spearman’s test. The diagnostic values of the XIST expression for detecting AF were an-alyzed by receiver operating characteristic (ROC) curves. Results: The expression levels of XIST were lower in serum of patients with AF than that in healthy controls (P < 0.05). The expression levels of XIST were lower in serum of patients with persistent and permanent AF than that in pa-tients with paroxysmal AF (P < 0.05). The expression levels of XIST were lower in serum of AF pa-tients with CHA2DS2-VASc score ≥ 2 than that in AF patients with CHA2DS2-VASc score < 2 (P < 0.05). The expression levels of XIST were lower in serum of AF patients with cardiac function class III~IV than that in AF patients with cardiac function class I~II (P < 0.05). XIST expression was posi-tively correlated with LVEF (r = 0.48, P < 0.05), but negatively correlated with LAD (r = −0.73, P < 0.05). The area under the curves of XIST expression for the diagnosis of AF, paroxysmal AF, persis-tent AF and permanent AF were 0.66, 0.69, 0.77 and 0.82, respectively (P < 0.05). Conclusion: The expression levels of XIST are downregulated in serum of AF patients and correlates with AF type, CHA2DS2-VASc score, cardiac function class, LVEF and LAD. XIST expression has a role in assisting in the diagnosis of AF.