血浆游离DNA作为急性冠状动脉综合征诊断生物标志物的价值  

Plasma cell-free DNA as a biomarker for the diagnosis of acute coronary syndrome

作　　者：丛辉[1] 景蓉蓉[1] 王惠民[1] 吴晓晖[2] 储海丹[1] 范勐康 鞠少卿[1] CONG Hui;JING Rongrong;WANG Huimin;WU Xiaohui;CHU Haidan;FAN Mengkang;JU Shaoqin(Department of Clinical Laboratory,Affiliated Hospital of Nantong University,Nantong 226001,Jiangsu,China;Department of Cardiology,Affiliated Hospital of Nantong University,Nantong 226001,Jiangsu,China)

机构地区：[1]南通大学附属医院检验科,江苏南通226001 [2]南通大学附属医院心内科,江苏南通226001

出　　处：《检验医学》2016年第12期1021-1025,共5页Laboratory Medicine

基　　金：江苏省"六大人才高峰"项目(WS-066);南通市社会事业科技创新与示范项目(HS2014059)

摘　　要：目的 以Alu为靶基因，探讨血浆游离DNA（cfDNA）作为急性冠状动脉综合征（ACS）诊断生物标志物的价值。方法 采用基于Alu基因的支链DNA（bDNA）技术定量检测140例ACS患者（ACS组）和60名健康体检者（正常对照组）血浆cfDNA水平，并对部分行经皮冠状动脉介入治疗（PCI）术的ACS患者进行术前和术后的动态观测。采用化学发光法检测心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）、肌红蛋白（MYO）水平，分析cfDNA与cTnI、CK-MB、MYO的相关性，采用受试者工作特征（ROC）曲线评价cfDNA诊断ACS的价值。结果 ACS组血浆cfDNA水平为2550.3（969.9～4866.4）ng/mL，明显高于正常对照组[118.3（81.1～221.1）ng/mL，P<0.001]。10例行PCI术的ACS患者术前、术后血浆cfDNA水平差异无统计学意义（P>0.05），但术后呈下降趋势。cfDNA与cTnI、CK-MB、MYO水平无相关性（r2=0.031、0.152、0.217，P>0.05）。ROC曲线分析显示cfDNA诊断ACS的ROC曲线下面积（0.95）和敏感性（82.76%）优于cTnI（0.57和22.41%）、CK-MB（0.81和20.69%）及MYO（0.64和10.34%），4项指标的特异性均为100.00%。结论ACS患者cfDNA水平明显升高，其临床诊断效能明显高于目前临床常用的心肌标志物，可作为诊断ACS重要的生物学指标。Objective To investigate the significance of plasma cell-free DNA(cfDNA) as a biomarker forthe diagnosis of acute coronary syndrome(ACS) by choosing Alu as a target gene. Methods Blood specimens of140 patients with ACS(ACS group) and 60 healthy subjects(healthy control group) were collected. A branchedDNA(bDNA) assay based on Alu gene was used to determine the concentration of cfDNA,and the serial changesof cfDNA concentrations were observed dynamically in some ACS patients before and after percutaneous coronaryintervention(PCI). The concentrations of cardiac troponin I(cTnI),creatine kinase-MB(CK-MB) andmyoglobin(MYO) were determined by chemiluminescence assay,and the correlations of cfDNA with cTnI,CK-MB and MYO were analyzed. Receiver operating characteristic (ROC) curve was performed for evaluatingthe significance of cfDNA in the diagnosis of ACS. Results The concentration of cfDNA was higher in ACS group[2 550.3(969.9-4 866.4) ng/mL] than that in healthy control group [118.3(81.1-221.1) ng/mL,P<0.001]. Theconcentration of cfDNA was decreased in 10 patients after PCI,and there was no statistical significance for cfDNAconcentration before and after PCI(P>0.05). No correlation was found between cfDNA concentration and cTnI,CK-MB,MYO in patients with ACS (r2=0.031,0.152 and 0.217,P>0.05). ROC curves showed that the areasunder the curves(0.95) and the sensitivities of cfDNA(82.76%) were better than those of cTnI(0.57 and22.41%),CK-MB(0.81 and 20.69%) and MYO(0.64 and 10.34%). The specificities of the 4 parameters wereall 100.00%. Conclusions Plasma concentration of cfDNA is increased in ACS patients,its diagnosis significanceis better than those of commonly-used myocardial biomarkers,and cfDNA may be an important biomarker for thediagnosis of ACS.

关 键 词：游离DNA Alu基因 生物标志物 急性冠状动脉综合征 

分 类 号：Q503[生物学—生物化学]