摘要
目的：评估循环微小RNA-1（miR-1）早期诊断急性心肌梗死（AMI）的诊断价值。方法采用前瞻性队列研究方法，入选2012年11月至2015年6月无锡市第二人民医院就诊的所有胸痛患者，根据AMI诊断标准将患者分为AMI组与非AMI组；以同期健康体检者作为健康对照组。取患者发病3h内静脉血，通过实时定量反转录-聚合酶链反应（RT-PCR）检测血浆miR-1含量；采用电化学放光法检测心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）水平。Spearman秩相关法分析AMI患者血浆miR-1水平与cTnI、CK-MB的相关性；受试者工作特征曲线（ROC）分析血浆miR-1、cTnI、CK-MB对AMI的早期诊断效能。结果 AMI组127例；非AMI组107例，其中心绞痛82例，肺栓塞2例，主动脉夹层3例，急性心包炎2例，心肌炎3例，急性心力衰竭13例，消化性溃疡2例；健康对照组90例。AMI组与非AMI组性别、高脂血症方面无差异。AMI组血浆miR-1、cTnI、CK-MB较非AMI组和健康对照组升高〔miR-1（2-ΔΔCt）：4.32±2.60比1.44±0.75和0.98±0.18；cTnI（μg/L）：3.23（0.63，10.70）比0.02（0.00，0.17）和0.00（0.00，0.00）；CK-MB（U/L）：32.40（14.20，95.40）比14.40（11.20，17.10）和8.90（8.28，9.50），均P＜0.01〕。AMI患者血浆miR-1与cTnI、CK-MB均呈显著正相关（r1＝0.395、r2＝0.490，均P＜0.000）。ROC曲线分析显示，miR-1诊断AMI的ROC曲线下面积（AUC）为0.905〔95%可信区间（95%CI）＝0.860～0.950，P＝0.000〕，敏感度为86.6%，特异度为95.4%；cTnI的AUC为0.908（95%CI＝0.870～0.946，P＝0.000），敏感度为81.9%，特异度为95.9%；CK-MB的AUC为0.795（95%CI＝0.736～0.854，P＝0.000），敏感度为63.0%，特异度为92.9%。结论血浆miR-1可早期诊断AMI，其诊断效能优于CK-MB，且与cTnI相当，可以提供cTnI以外的诊断信息，二者联合应用可能有助于提高AMI早期诊断的准确性。
Objective To evaluate the early diagnostic value of circulating microRNA-1 （miR-1） on acute myocardial infarction （AMI）. Methods A prospective cohort study was conducted. The patients with chest pain admitted to the Second People＆#39;s Hospital of Wuxi from November 2012 to June 2015 were enrolled. According to AMI diagnostic criteria, the patients were divided into AMI group and non-AMI group, and healthy individuals during the same period were served as heath controls. The venous samples of the onset patients were collected within 3 hours after admission. The plasma miR-1 was determined by real-time quantitative reverse transcription-polymerase chain reaction （RT-PCR）, and the levels of plasma cardiac troponin I （cTnI） and MB isoenzyme of creatine kinase （CK-MB） were measured by electrochemiluminescence. The correlation between plasma miR-1 and cTnI as well as CK-MB was performed by Spearman analysis. The early diagnostic performance of plasma miR-1, cTnI, and CK-MB for AMI was estimated by receiver operating characteristic （ROC） curve analysis. Results There were 127 patients in AMI group, and 107 in non-AMI group, including 82 patients with angina pectoris, 2 with pulmonary embolism, 3 with aortic dissection, 2 with acute pericarditis, 3 with myocarditis, 13 with acute heart failure, and 2 with peptic ulcer. Ninety volunteers were served as healthy controls. There was no difference in clinical characteristics including gender and hyperlipidemia between AMI group and non-AMI group. The expressions of plasma miR-1, cTnI and CK-MB were significantly increased in AMI patients as compared with those of the healthy controls [miR-1 （2-ΔΔCt）： 4.32±2.60 vs. 1.44±0.75 and 0.98±0.18, cTnI （μg/L）： 3.23 （0.63, 10.70） vs. 0.02 （0.00, 0.17） and 0.00 （0.00, 0.00）, CK-MB （U/L）： 32.40 （14.20, 95.40） vs. 14.40 （11.20, 17.10） and 8.90 （8.28, 9.50）, all P ＆lt; 0.01]. The expression of plasma miR-1 had a significantly positive correlation with cTnI and CK-
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2016年第7期607-611,共5页
Chinese Critical Care Medicine
基金
江苏省临床医学科技专项基金（BL2012042）
