魏青 叶日兰

【摘要】 目的：探究彩色多普勒超声联合微小RNA-222（miR-222）、微小RNA-21（miR-21）对老年退行性心脏瓣膜病的诊断价值。方法：选取2022年6月—2023年6月因不适（心悸、发力、胸痛等）在龙南市第一人民医院检查的患者100例作为研究组，以临床综合诊断为金标准，将其中确诊为老年退行性心脏瓣膜病的58例患者作为心脏瓣膜病组，并选取同时期在本院体检的健康志愿者90例作为正常组。所有患者行彩色多普勒超声检查，并检测miR-222、miR-21表达量。比较心脏瓣膜病组与正常组，以及不同严重程度瓣膜功能障碍患者miR-222、miR-21表达量，分析彩色多普勒超声、miR-222、miR-21联合诊断老年退行性心脏瓣膜病的价值。结果：彩色多普勒超声对老年退行性心脏瓣膜病的诊断准确度为84.00%（84/100），敏感度为82.76%（48/58），特异度为85.71%（36/42）。与正常组相比，心脏瓣膜病组miR-222、miR-21表达量均明显更高（P<0.05）。重度瓣膜功能障碍患者miR-222、miR-21表达量均明显高于轻度、中度患者，中度患者miR-222、miR-21表达量均高于轻度患者（P<0.05）。受试者操作特征（ROC）曲线分析显示，三项联合对老年退行性心脏瓣膜病诊断的曲线下面积（AUC）高于单项。结论：miR-222、miR-21在老年退行性心脏瓣膜病中表达水平较高，且随着病情严重程度的增加，miR-222、miR-21表达水平逐渐升高，联合检查彩色多普勒超声、miR-222、miR-21，具有较高诊断价值，可用于老年退行性心脏瓣膜病的临床诊断。

【关键词】 彩色多普勒超声 微小RNA-222 微小RNA-21 老年退行性心脏瓣膜病

Diagnostic Value of Color Doppler Ultrasound Combined with miR-222 and miR-21 in Senile Degenerative Heart Valvular Disease/WEI Qing， YE Rilan. //Medical Innovation of China， 2024， 21（14）： 124-128

[Abstract] Objective： To explore the diagnostic value of color Doppler ultrasound combined with microRNA-222 （miR-222） and microRNA-21 （miR-21） in senile degenerative heart valvular disease. Method： A total of 100 patients who were examined in Longnan First People's Hospital from June 2022 to June 2023 due to discomfort （palpitation， force， chest pain， etc.） were selected as the study group， taking comprehensive clinical diagnosis as the gold standard， 58 patients diagnosed with senile degenerative heart valvular disease were selected as the valvular heart disease group. In addition， 90 healthy volunteers who underwent physical examination in our hospital during the same period were selected as the normal group. All patients underwent color Doppler ultrasonography and the expression levels of miR-222 and miR-21 were detected. The expression levels of miR-222

and miR-21 were compared between the valvular heart disease group and the normal group and patients with different severity of valvular dysfunction. The value of combination of color Doppler ultrasound， miR-222 and miR-21

in the diagnosis of senile degenerative heart valvular disease were analyzed. Result： The diagnostic accuracy， sensitivity and specificity of color Doppler ultrasound for senile degenerative heart valvular disease were 84.00% （84/100）， 82.76% （48/58） and 85.71% （36/42） respectively. Compared with the normal group， the expression levels of miR-222 and miR-21 in the heart valvular disease group were significantly higher （P<0.05）. The expression levels of miR-222 and miR-21 in patients with severe valvular dysfunction were significantly higher than those in mild and moderate patients， the expression levels of miR-222 and miR-21 in patients with moderate valvular dysfunction were significantly higher than those in mild and moderate patients （P<0.05）. Receiver operating characteristics （ROC） curve analysis showed that the area under the curve （AUC） of the three combinations for the diagnosis of senile degenerative heart valvular disease was higher than that of the single diagnosis. Conclusion： The expression levels of miR-222 and miR-21 are high in senile degenerative heart valvular disease， and the expression levels of miR-222

and miR-21 gradually increase with the severity of the disease. The combined examination of color Doppler ultrasound， miR-222 and miR-21 have high diagnostic value and can be used in the clinical diagnosis of senile degenerative heart valvular disease.

[Key words] Color Doppler ultrasound microRNA-222 microRNA-21 Senile degenerative heart valvular disease

First-author's address： Department of Ultrasound， Longnan First People's Hospital， Longnan 341700， China

doi：10.3969/j.issn.1674-4985.2024.14.030

老年退行性心脏瓣膜病是心脏瓣膜结缔组织退行性变、纤维化和钙化引起的疾病，这些病理改变导致瓣膜及其支架功能异常[1]。临床上，此病多表现为钙化性主动脉瓣狭窄、二尖瓣环钙化和二尖瓣脱垂症[2]。患者可有心悸、乏力和胸痛等症状，在病情晚期症状严重而紧急[3]。鉴于早期症状可能不甚明显，且症状无特异性，准确的临床诊断对于改善患者的生存质量和预后至关重要。彩色多普勒超声作为非侵入性的诊断工具，能有效展示瓣膜的运动功能及其结构异常[4]。然而，单一使用彩色多普勒超声在某些情况下难以对微小病变进行准确诊断。……