循环microRNA208a和208b在急性心肌梗死早期诊断中的价值  

Early diagnostic value of circulating microRNA208a,208b in acute myocardial infarction

作　　者：Osor Oyunbileg 李广平[1] 王兴华[1] 徐昭[1] 

机构地区：[1]天津医科大学第二医院心脏科,天津市心血管病离子与分子重点实验室,300211

出　　处：《中国心血管杂志》2015年第1期13-17,共5页Chinese Journal of Cardiovascular Medicine

摘　　要：目的 探讨心肌特异性miR208a、miR208b作为早期急性心肌梗死（AMI）诊断指标的作用。方法 纳入天津医科大学第二医院住院的急性ST段抬高型心肌梗死（STEMI）患者30例,不稳定型心绞痛（UAP）患者20例及无心血管疾病（CVD）、心电图正常的健康人21例。所有入选者,以hs-nRNA U6为内参,利用SYBR实时荧光定量聚合酶链反应（qRT-PCRs）检测血浆中miR208a和miR208b的表达量,采集AMI发病后12 h内外周静脉血,第一份血液样本采集于患者刚入住冠心病监护病房（CCU）时,另一份则采集于次日早上6点（PCI术结束的数小时后）,分别测定miR208a、miR208b表达水平及cTnI的变化。结果 STEMI患者血浆中miR208a、miR208b表达水平显著高于健康对照组,分别为健康对照组的9.45倍（P〈0.001）和10.43倍（P〈0.001）。这些miRNA的表达水平在UAP患者血浆中均略有上升。19例急性STEMI患者胸痛发作3 h内,miR208a表达水平的升高率达100%（19例）,miR208b表达水平的升高率达89.5%（17例）,而患者同期cTnI呈阳性的比率仅有47.4%（9例）。STEMI患者与健康对照组的miR208a和miR208b的ROC曲线有明显差异,曲线下面积（AUC）分别为0.97（95%CI：0.937-1.011,P〈0.001）和0.938（95%CI：0.867-1.010,P〈0.001）,但miR208a、miR208b在急性STEMI和UAP组之间比较,AUC分别为0.739和0.750,而cTnI的AUC为0.900。结论 血浆miR208a和miR208b可能是潜在的早期、快速、准确诊断AMI的生物标志物,但对STEMI和UAP进行鉴别诊断的价值有限,不及cTnI。Objective To investigate the early diagnostic value of specific miR208a, miR208b in acute myocardial infarction （ AMI ） . Methods A total of 30 patients with acute ST segment elevation myocardial infarction （ STEMI） , 20 unstable angina pectoris （ UAP） and 21 normal subjects were enrolled. Using hs-nRNA U6 as reference, miR208a and miR208b expressions were measured by SYBR qRT-PCRs. miR208a, miR208b expressions and cTNI determined in venous blood samples within 12 h after onset of AMI, first sample taken at admission and second sample at 6 am next morning. Results miR208a and miR208b expressions were significantly higher in patients with STEMI than in healthy subjects by about 9. 45 times and 10. 43 times （ both p〈 0. 001 ） , respectively. miRNAs＇ expressions in UAP patients were increased slightly. Within the first 3 h after episode, the expressions of miR208a and miR208b in patients with acute STEMI were increased in 100% （ 19/19 ） and 89. 5% （ 17/19 ） of the patients, respectively. Meanwhile, cTnI positive occurred only in 47. 4% （9/19）of the patients. There was a significant difference in miR208a and miR208b expressions between STEMI patients and healthy controls. The area under curve （AUC） was 0. 97 （95%CI：0. 937—1. 011,p〈0. 001） and 0. 938 （95%CI：0. 867—1. 010, p〈0. 001） respectively. The AUC of miR208a and miR208b was 0. 739 in acute STEMI and 0. 750 in UAP. However, the AUC of cTnI was 0. 900. Conclusions Plasma miR208a and miR208b act as potential biomarkers for the early and accurate diagnosis of AMI. The differential diagnostic efficacy of miR208a and miR208b for STEMI and UAP are lower than cTnI.

关 键 词：心肌梗死 循环MICRORNA 生物标志物 miR208a miR208b 

分 类 号：R542.22[医药卫生—心血管疾病]