血浆microRNA-497表达水平与急性心肌梗死的相关性

肖亚利; 赵敏; 吕平; 刘瑞娟; 王金艳; 崔涛

doi:10.3969/j.issn.2095-5227.2017.02.008

血浆microRNA-497表达水平与急性心肌梗死的相关性

Correlation between the level of microRNA-497 expression in plasma and acute myocardial infarction

摘要

摘要: 目的探讨血浆microRNA-497表达水平与急性心肌梗死(acute myocardial infarction，AMI)的相关性。方法选取2015年1月- 2016年9月于河北省涿州市医院就诊的疑似AMI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对照组。荧光定量反转录-聚合酶链反应(reverse transcriptase-polymerase chain reaction，RT-PCR)检测血浆microRNA-497含量，电化学发光法检测心肌肌钙蛋白Ⅰ(cardiac troponinⅠ，cTnⅠ)及肌酸激酶同工酶(creatine kinase isoenzyme，CK-MB)水平。应用受试者工作特征曲线分析血浆microRNA-497、cTnⅠ及CK-MB对AMI的诊断价值，多元Logistic回归模型分析血浆microRNA-497与AMI的关系。Spearman秩相关分析AMI患者血浆microRNA-497水平与cTnⅠ、CK-MB的相关性。结果 AMI组血浆microRNA-497、CTnⅠ及CK-MB水平3.41±0.94；2.94(0.57，10.25)；37.48(18.75，101.28)较非AMI组1.35±0.63；0.06(0.01，0.21)；16.73(13.46，19.57)和对照组0.64±0.12；0.00(0.00，0.00)；9.25(8.36，9.92)明显升高(P均< 0.05)。血浆microRNA-497、cTnⅠ及CK-MB诊断AMI的曲线下面积及95%CI分别为0.895(0.831 ～ 0.960)、0.902(0.839 ～ 0.968)、0.784(0.726 ～ 0.843)，当microRNA-497取值为1.58时，其诊断AMI的敏感度和特异度最好，分别为85.0%和94.2%。Logistic回归分析显示，血浆microRNA-497及cTnⅠ为AMI的独立危险因素(OR=2.637，95%CI：1.574 ～ 5.327；OR=2.152，95%CI：1.126 ～ 4.975；P均< 0.05)。AMI患者血浆microRNA-497与cTnⅠ、CK-MB均呈正相关(r=0.673、0.328，P均< 0.01)。结论血浆microRNA-497可作为早期诊断AMI的生物学指标，其诊断效能与cTnⅠ相当，二者联合应用有望提高AMI早期诊断的准确性。

Abstract: Objective To investigate the expression of plasma microRNA-497 in patients with acute myocardial infarction (AMI) and its correlation with AMI. Methods From January 2015 to September 2016 in Zhuozhou City Hospital Hebei province, suspected AMI patients (according to the AMI diagnostic criteria) were divided into AMI group and non AMI group, and healthy people received health screening in the same period served as the control group. The plasma microRNA-497 was determined by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR), and the levels of plasma cardiac troponinⅠ(cTnⅠ) and MB isoenzyme of creatine kinase (CK-MB) were measured by electrochemiluminescence. The diagnostic values of plasma microRNA-497, cTnⅠ and CK-MB for AMl were estimated by receiver operating characteristic (ROC) curve analysis, and the relationship between plasma microRNA-497 and AMI was analyzed by multivariate logistic regression model. The correlation between plasma microRNA-497 and cTnⅠ as well as CK-MB was detected by Spearman correlation analysis. Results The expressions of microRNA-497, cTnⅠ and CK-MB were significantly increased in AMI patients3.41±0.94; 2.94(0.57, 10.25); 37.48(18.75, 101.28) as compared with those of non AMI group1.35±0.63; 0.06(0.01, 0.21); 16.73(13.46, 19.57) and the healthy controls0.64±0.12; 0.00(0.00, 0.00); 9.25(8.36, 9.92)(P< 0.05, respectively). The AUC of plasma microRNA-497, cTnⅠ and CK-MB in the diagnosis of AMI and 95%CI were 0.895 (0.831 to 0.960), 0.902 (0.839 to 0.968), 0.784 (0.726 to 0.843). The cut-off value of microRNA-497 was 1.58 with diagnostic sensitivity and specificity of 85% and 94.2%. Logistic regression analysis showed that plasma microRNA-497 and cTnⅠ were the independent risk factors for AMI. (OR=2.637, 95%CI:1.574 to 5.327, OR=2.152, 95%CI:1.126 to 4.975, P< 0.05 respectively). The plasma levels of microRNA-497 was positively correlated with cTnⅠ(r=0.673, P< 0.01) and CK-MB in patients with AMI (r=0.328, P< 0.01). Conclusion Plasma microRNA-497 can be used as a biological indicator for early diagnosis of AMI, and its diagnostic efficacy is comparable to that of cTnⅠ, and the combined application of the two is expected to improve the accuracy of early diagnosis of AMI.

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