摘要
目的探讨血浆微小RNA-21(miR-21)对急性心肌梗死(AMI)早期诊断及短期预后判断的价值。方法纳入AMI患者62例(AMI组),另选取同期在本院体检中心健康体检者30例(对照组)。AMI组于急性胸痛发作6h以内、12h、24h、7d、14d采集静脉血,通过定量逆转录聚合酶链反应(qRT-PCR)检测血浆miR-21相对表达水平;采用电化学免疫荧光法检测心肌肌钙蛋白T(cTnT)水平。并随访6个月观察主要心血管不良事件(MACE)的发生情况。结果(1)AMI组患者入院6h以内cTnT水平及血浆miR-21相对表达水平明显高于对照组(P<0.01)。(2)血浆miR-21水平在入院6h内开始增高,12h达到高峰,24h、7d、14d逐渐下降至接近正常。cTnT在入院6h内开始增高,24h达到高峰,7d、14d逐渐下降至接近正常。(3)入院6h以内和入院12h血浆miR-21的ROC曲线下面积(AUC)分别为0.939(95%CI:0.893~0.984,P=0.000)和0.956(95%CI:0.918~0.994,P=0.000);入院6h以内和入院12h血浆cTnT的AUC分别为0.964(95%CI:0.932~0.996,P=0.000)和0.979(95%CI:0.956~1.000,P=0.000)。(4)随访6个月后,发生MACE的患者在入院6h、12h、24h、7d、14d血浆miR-21相对表达水平与未发生MACE的患者比较,差异均有统计学意义(均P<0.01)。结论检测miR-21水平对AMI的早期诊断和预后评估具有一定的临床参考价值,但并不优于cTnT的检测价值。
Objective To analyze the value of plasma microRNA-21（miR-21）in the early daignosis and short-term prognosis of aucte myocardial infarction.Methods Sixty-two patients with acute myocardial infarction（AMI group,n=62）were enrolled in the study.Plasma miR-21 levels were measured by quantitative reverse transcription polymerase chain reaction（qRT-PCR）within 6 h,12 h,24 h,7 dand 14 dafter the onset of acute chest pain.Plasma cTnT levels were measured by electrochemiluminescence-based methods.The major adverse cardiovascular events（MACE）were recorded during the follow-up of 6 months.In the same period,30 healthy subjects（control group,n=30）were enrolled.Results The level of cTnT within 6 hours of symptoms onset in AMI group was significantly higher than that in control group（P〈0.01）.The level of miR-21 within 6 hours of symptoms onset in AMI group was significantly higher than that in control group（P〈0.01）.miR-21 level began to increase within 6 hours of symptoms onset,reached a peak at 12 h,and decreased gradually to normal at 24 h,7 dand 14 d.cTnT level began to increase within 6 hafter onset,reached a peak at24 h,and decreased gradually to normal at 7 dand 14 d.The area under curve（AUC）for miR-21 within 6 hours of symptoms onset was 0.939（95%CI：0.893-0.984,P=0.000）.The AUC for miR-21 at 12 hwas 0.956（95%CI：0.918-0.994,P=0.000）;The AUC for cTnT within 6 hours of symptoms onset was 0.964（95%CI：0.932-0.996,P=0.000）.The AUC for cTnT at 12 hwas 0.979（95%CI：0.956-1.000,P=0.000）.After following-up for 6 months,there was a statistically significant difference in the level of plasma miR-21 expression between patients with MACE and patients without MACE at 6 h,12 h,24 h,7 dand 14 d（all P〈0.01）.Conclusion The level of miR-21 has a certain reference value for the early diagnosis and prognosis of AMI,but it is not superior to cTnT.
作者
郝谦
吴慧琴
杨捍卫
HAO Qian;WU Huiqin;YANG Hanwei(Wuhan General Hospital of PLA,Wuhan 430070,China)
出处
《西部医学》
2018年第9期1356-1360,共5页
Medical Journal of West China
