miR-133a对急性心肌梗死的早期诊断及预后评估价值  

Early diagnosis and prognostic evaluation value of miR-133a in patients with acute myocardial infarction

作　　者：唐冬娟 薛晓梅[1] 何斌[1] TANG Dong-juan;XUE Xiao-mei;HE Bin(Department of Anesthesiology and SICU,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院麻醉与重症医学科,上海200092

出　　处：《上海交通大学学报（医学版）》2020年第3期339-345,共7页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家自然科学基金(81470390);上海市科学技术委员会临床重点项目(17411954700);上海交通大学“转化医学交叉研究基金”(ZH2018ZDB01);上海申康临床三年行动计划(16CR3006A)。

摘　　要：目的·研究血清中mi R-133a对急性心肌梗死(acute myocardial infarction,AMI)的早期诊断价值及30 d内心血管不良事件发生率的评估价值。方法·纳入紧急胸痛发作6 h内就诊的患者90例,最终确诊AMI 63例、不稳定型心绞痛(unstable angina pectoris,UAP)13例和其他病因胸痛(对照)14例。电化学荧光法检测所有患者肌钙蛋白(troponin I,cTnI)、肌酸激酶同工酶(creatine kinase MB,CK-MB)和肌红蛋白(myoglobin,Mb)水平。实时荧光定量PCR(quantitative real-time PCR,qPCR)检测患者入院即刻和经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后24 h血清中的miR-133a表达水平。记录行冠状动脉造影检查的患者Gensini评分。随访患者30 d内心血管不良事件的发生情况。采用Spearman相关分析、多因素Logistic回归分析并绘制受试者工作特征曲线(receiver operator characteristic curve,ROC曲线)对相应数据进行分析。结果·miR-133a在AMI组较UAP组和对照组的表达显著升高(均P<0.05)。Spearman相关分析显示,mi R-133a的表达量与cTnI、CK-MB、Mb水平及Gensini评分均呈正相关(均P<0.05)。多因素Logistic回归分析显示,mi R-133a和冠状动脉粥样硬化性心脏病史是AMI发生的独立危险因素。ROC曲线分析显示,miR-133a诊断AMI的曲线下面积(area under the curve,AUC)为0.816(95%CI 0.716~0.917),预测30 d内心血管不良事件发生的AUC为0.700(95%CI 0.535~0.865)。结论·AMI患者的miR-133a水平显著升高,其有望作为AMI早期诊断的生物标志物;血清中miR-133a水平与冠状动脉狭窄程度及预后可能存在一定的相关性。Objective · To investigate the value of serum miR-133 a in early diagnosis and the assessment of 30-day incidence of cardiovascular adverse events in patients with acute myocardial infarction(AMI). Methods · Ninety patients with acute chest pain within 6 h were included, and 63 cases of AMI, 13 cases of unstable angina pectoris(UAP) and 14 cases of control(chest pain of other causes) were finally diagnosed. The levels of troponin I(cTnI), creatine kinase MB(CK-MB) and myoglobin(Mb) were measured by electrochemical fluorescence. Quantitative real-time PCR(qPCR) was used to detect the expression of miR-133 a in the serum of patients immediately after admission and 24 h after percutaneous coronary intervention(PCI). The Gensini score of patients who underwent coronary angiography was recorded. The incidence of cardiovascular adverse events was observed within 30 days. Spearman correlation analysis, multivariate Logistic regression analysis and receiver operator characteristic curve(ROC curve) were used to analyze the corresponding data. Results · The expression of miR-133 a in the AMI group was significantly higher than that in the UAP group and the control group(both P<0.05). Spearman correlation analysis showed that the expression of miR-133 a was positively correlated with cTnI, CK-MB, MB level and Gensini scores(all P<0.05). Multivariate Logistic regression analysis showed that miR-133 a and the history of coronary heart disease were independent risk factors for AMI. ROC curve showed that the area under the curve(AUC) of miR-133 a in the diagnosis of AMI was 0.816(95% CI 0.716-0.917), and the AUC of 30 days cardiovascular adverse event was 0.700(95% CI 0.535-0.865). Conclusion · The expression of miR-133 a in patients with AMI is significantly increased, which is expected to be a biomarker for early diagnosis of AMI. The expression level of miR-133 a in serum may be related to the severity of coronary artery disease and short-term prognosis.

关 键 词：急性心肌梗死 miR-133a 生物标志物 早期诊断 预后 

分 类 号：R541.4[医药卫生—心血管疾病]