血清miR-208a在急性冠状动脉综合征早期鉴别诊断中的价值  

The clinical value of serum Mir-208a in early differential diagnosis of acute coronary syndrome

作　　者：耿国英[1] 刘恒亮[1] 赵玉洁[1] 巴宁[1] 毛磊[1] 吴雷[1] 陈文山[1] Geng Guoying;Liu Hengliang;Zhao Yujie;Ba Ning;Mao Lei;Wu Lei;Chen Wenshan(Department of Cardiovascular Medicine,Zhengzhou People's Hospital,Zhengzhou 450000,China)

机构地区：[1]郑州人民医院心血管内科,450000

出　　处：《中华老年医学杂志》2020年第8期874-878,共5页Chinese Journal of Geriatrics

摘　　要：目的探讨血清miR-208a在急性冠状动脉综合征(ACS)患者早期鉴别诊断中的临床价值。方法选取2016年1月至2018年1月在我院心内科收治的100例ACS患者为研究对象,分为非ST端抬高性心肌梗死组(NSTEMI组)和不稳定型心绞痛组(UA组),各50例;选取同期的50例健康人为对照组。对比三组患者入院即刻、4 h、12 h、24 h血清中miR-208a、肌钙蛋白T(cTnT)和肌酸激酶同工酶(CK-MB)的水平变化;ROC曲线分析入院即刻上述血清指标分别在诊断NSTEMI和UA中的早期诊断价值,并分析miR-208a水平与cTnT、CK-MB的相关性。结果治疗入院即刻及对照组空腹状态下,三组血清miR-208a、cTnT水平差异存在统计学意义(P<0.05);血清CK-MB水平比较,差异无统计学意义(P>0.05)。不同监测时间点NSTEMI组和UA组患者血清miR-208a、cTnT和CK-MB水平差异均存在统计学意义(P<0.05);进一步经多重比较,结果发现:(1)两组患者入院即刻血清miR-208a和cTnT水平比较,结果均存在统计学差异(P<0.05),血清CK-MB水平无统计学差异(P>0.05);(2)入院后4、12、24 h,组间上述三种生化指标比较,结果均存在统计学差异(P<0.05)。ROC曲线分析显示,miR-208a在ACS中具有较高诊断价值(AUC>0.9,P=0.004),其中最佳诊断参数为9.278;cTnT在诊断中具有中等诊断价值(0.7<AUC<0.9,P=0.013),最佳诊断值为5.147 μg/L;CK-MB指标具有较低诊断价值(0.5<AUC<0.7,P=0.031),此时最佳诊断值为82.716 U/L。ACS患者中血清miR-208a水平与cTnT水平呈正相关(P<0.05),与CK-MB水平无相关性(P>0.05)。结论血清miR-208a在ACS患者的早期诊断效果优于cTnT和CK-MB,对NSTEMI的鉴别能力优于UA。Objective To investigate the clinical value of serum miR-208a in early differential diagnosis of acute coronary syndrome(ACS).Methods One hundred ACS patients admitted to our department from January 2016 to January 2018 were randomly divided into the non-ST elevation myocardial infarction(NSTEMI)group(n=50)and the unstable angina(UA)group(n=50).Fifty healthy people during the same period were included as the control group(control).Serum levels of miR-208a,cardiac troponin-T(cTnT)and creatine kinase MB isoenzyme(CK-MB)were detected immediately,4 h,12 h and 24 h after admission and compared among the three groups of NSTEMI,UA and control.Receiver operating characteristic(ROC)curve was used to analyze the early diagnostic value of above serum indexes in NSTEMI and UA group,and the correlations of miR-208a level with cTnT and CK-MB were analyzed.Results Serum miR-208a and cTnT levels had significant differences(P<0.05),while serum CK-MB level had no significant difference(P>0.05)among the NSTEMI and UA groups immediately after admission and the control group in the fasting state.There were significant differences in serum miR-208a,cTnT and CK-MB levels between NSTEMI group and UA group at different time points(P<0.05).After further multiple comparisons,the results showed that serum miR-208a and cTnT levels had statistical differences(P<0.05)and serum CK-MB level had no difference(P〉0.05)between the NSTEMI group and the UA group immediately after admission.The above three biochemical indexes showed statistically significant differences between the NSTEMI group and the UA group at 4 h,12 h and 24 h after admission(P<0.05).ROC curve analysis showed that miR-208a had a high diagnostic value in ACS(AUOO.9,P=0.004),and the best diagnostic cut-off point was 9.278.The cTnT had a medium diagnostic value in ACS(0.7<CAUC<0.9,P=0.013),and the diagnostic cut-off point was 5.147/ng/L.CK-MB had a low diagnostic value in ACS(0.5<AUC<0.7,P=0.031),and the diagnostic cut-off point was 82.716 u/1.Serum miR-208a level was positively co

关 键 词：miR-208a RNA 信使 急性冠状动脉综合征 

分 类 号：R541.4[医药卫生—心血管疾病]