血清miR-1联合cTn I、TNF-α对病毒性心肌炎诊断及预后评估的价值分析  

The Value Evaluation of Serum miR-1 Combined with cTn I and TNF-α in the Diagnosis and Prognosis of Viral Myocarditis

作　　者：霍明艳[1] 张娜[1] 胡娜[1] 孙立[1] 王虹[1] HUO Ming-yan;ZHANG Na;HU Na;SUN Li;WANG Hong(Department of Cardiology,Affiliated Hospital of Chengde Medical College,Chengde 067000,China)

机构地区：[1]承德医学院附属医院心脏内科

出　　处：《标记免疫分析与临床》2019年第7期1190-1195,共6页Labeled Immunoassays and Clinical Medicine

摘　　要：目的探究血清微小核糖核酸-1(microRNA-1,miR-1)联合肌钙蛋白I(cardiac troponin I,cTnI)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)对病毒性心肌炎诊断及预后的价值。方法收集病毒性心肌炎患者86例,心肌梗死患者80例,和健康对照100例。采用酶联免疫吸附试验检测TNF-α水平,采用化学发光法检测cTnI水平,应用荧光定量聚合酶链式反应(real-time polymerase chain reaction,RT-PCR)对miR-1进行相对定量。结果与健康对照(miR-1:14.14±1.33(-log);TNF-α:57.84±5.22ng/L)和心肌梗死(miR-1:15.16±1.67(-log);TNF-α:82.15±6.15ng/L)相比,病毒性心肌炎患者血清miR-1(31.61±2.12(-log))和TNF-α(122.62±7.14ng/L)显著增高(P<0.05),心肌梗死患者血清TNF-α(82.15±6.15ng/L)和cTnI(1.72±0.18μg/L)显著高于健康对照(TNF-α:57.84±5.22ng/L;cTnI:0.12±0.02μg/L)(P<0.05),而健康对照和心肌梗死血清miR-1差异无统计学意义(P>0.05)。相比于低miR-1、TNF-α和cTnI水平组,高miR-1、TNF-α和cTnI水平组的临床痊愈率与恢复迁延率均明显降低,而心律失常与扩张型心肌病的发生率均显著增高(P<0.05)。血清miR-1、TNF-α和cTnI水平与病毒性心肌炎患者临床痊愈、恢复迁延、心律失常和扩张型心肌病发生均具有显著相关性(P<0.05)。ROC曲线显示,血清miR-1、TNF-α和cTnI在区分病毒性心肌炎和健康人群的曲线下面积(areaundercurve,AUC)分别为:0.902(95%CI:0.841~0.964,P<0.001)、0.789(95%CI:0.704~0.875,P<0.001)和0.685(95%CI:0.594~0.778,P<0.001),灵敏度/特异性分别为:80.2%/98.9%、79.1%/87.4%和68.8%/61.4%;诊断界值分别为:26.78(-log)、88.42ng/L和0.28μg/L。联合血清miR-1、TNF-α和cTnI在区分病毒性心肌炎和健康人群的AUC为0.932(95%CI:0.879~0.985,P<0.001),灵敏度90.2%,特异性91.7%。结论联合检测血清miR-1、TNF-α和cTnI对病毒性心肌炎具有较高诊断价值,亦可作为病毒性心肌炎预后评估的有效指标。Objective To explore the value of serum microRNA-1(miR-1)combined with cardiac troponin I(cTn I)and tumor necrosis factor-α(TNF-α)in the diagnosis and prognosis of viral myocarditis.Methods 86 patients with viral myocarditis,80 patients with myocardial infarction,and 100 healthy controls were collected for the study.The level of TNF-α was detected by enzyme-linked immunosorbent assay(ELISA),cTn I level was detected by chemiluminescence method,and miR-1 was quantitatively quantified by real-time PCR(RT-PCR).Results Compared with healthy controls(miR-1:14.14±1.33(-log);TNF-α:57.84± 5.22 ng/L )and myocardial infarction(miR-1:15.16±1.67(-log);TNF-α:82.15±6.15 ng/L),serum miR-1( 31.61± 2.12(-log))and TNF-α(122.62±7.14 ng/L)were significantly increased in patients with viral myocarditis( P <0.05).Serum TNF-α(82.15±6.15 ng/L)and cTn I(1.72±0.18 μ g/L)were significantly higher in patients with myocardial infarction than in healthy controls(TNF-α:57.84± 5.22 μ g/L;cTn I:0.12± 0.02 μ g/L)( P <0.05).There was no significant difference in serum miR-1 between healthy controls and myocardial infarction patients( P >0.05).Compared with the group of low miR-1,TNF-α and cTn I levels,the clinical recovery rate and recovery delay rate were significantly lower in the group of high miR-1,TNF-α and cTn I levels,whereas arrhythmia and dilated cardiomyopathy was significantly increased( P < 0.05 ).Spearman correlation analysis showed that serum miR-1,TNF-α and cTn I levels were significantly associated with clinical recovery,recovery delay,arrhythmia and dilated cardiomyopathy in patients with viral myocarditis( P <0.05).Receiver operating characteristic curve(ROC)curve analysis showed that the area under the curve(AUC)of serum miR-1,TNF-α and cTn I for the performances of the differentiation of viral myocarditis and healthy people were:0.902(95% CI:0.841-0.964,P <0.001),0.789(95% CI:0.704-0.875,P <0.001)and 0.685(95% CI:0.594-0.778,P < 0.001 ),sensitivity/specificity were:80.2%/ 98.9%,79.1%/87.4%,and 68.8%/61.4

关 键 词：病毒性心肌炎 微小核糖核酸 心肌肌钙蛋白I 肿瘤坏死因子-α 

分 类 号：R446.6[医药卫生—诊断学] R542.21[医药卫生—临床医学]