循环微小RNA-1对稳定性冠心病患者发生冠状动脉斑块破裂的早期诊断价值  

The value of circulating microRNA-1 in the early diagnosis of coronary atherosclerotic plaque rupture in patients with stable coronary heart disease

作　　者：苏彤 邵小南[2] 杨玲[1] 张晓璞[3] 杨承健[4] Su Tong;Shao Xiaonan;Yang Ling;Zhang Xiaopu;Yang Chengjian(Department of Cardiology,the Third Affiliated Hospital of Soochow University,the First People's Hospital of Changzhou,Changzhou 213003,Jiangsu,China;Department of Nuclear Medicine,the Third Affiliated Hospital of Soochow University,the First People's Hospital of Changzhou,Changzhou 213003,Jiangsu,China;Department of Neurology,the Third People's Hospital of Changzhou,Changzhou 213001,Jiangsu,China;Department of Cardiology,the Second People's Hospital of Wuxi Affiliated to Nanjing Medical University,Wuxi 214000,Jiangsu,China)

机构地区：[1]苏州大学附属第三医院,常州市第一人民医院心内科,江苏常州213003 [2]苏州大学附属第三医院,常州市第一人民医院核医学科,江苏常州213003 [3]常州市第三人民医院神经内科,江苏常州213001 [4]南京医科大学附属无锡市第二人民医院心内科,江苏无锡214000

出　　处：《中华危重病急救医学》2021年第5期568-572,共5页Chinese Critical Care Medicine

基　　金：江苏省临床医学科技专项(BL2012042)。

摘　　要：目的评估循环微小RNA-1(miR-1)对稳定性冠心病(SCAD)患者早期发生冠状动脉(冠脉)斑块破裂的诊断价值。方法采用前瞻性队列研究方法,纳入苏州大学附属第三医院心血管内科2019年1月至6月收治住院的67例SCAD患者,入选患者均完善冠脉造影(CAG),根据CAG结果进行经皮冠脉介入治疗(PCI)单支架植入或仅行CAG。分别于患者术前(0 h)、术后3 h取静脉血,通过实时定量反转录-聚合酶链反应(RT-PCR)检测血浆miR-1表达量,用电化学发光法检测心肌肌钙蛋白I(cTnI)水平。比较PCI或CAG患者术前与术后miR-1、cTnI水平的差异,评估其早期诊断SCAD患者冠脉斑块破裂的潜力,以受试者工作特征曲线(ROC曲线)评价其诊断效能。结果CAG组38例,PCI组29例。两组患者性别、年龄、既往史(除外高血压史)、心功能基线资料比较差异均无统计学意义。PCI组术后miR-1表达量显著高于术前〔2^(-ΔΔCt):2.11(1.56,2.73)比1.26(1.07,1.92),P<0.01〕,术前与术后cTnI水平差异无统计学意义〔μg/L:0.00(0.00,0.02)比0.00(0.00,0.02),P>0.05〕;而CAG组术前与术后miR-1和cTnI水平差异均无统计学意义〔miR-1(2^(-ΔΔCt)):1.09(1.00,1.40)比1.21(1.00,1.71),cTnI(μg/L):0.00(0.00,0.02)比0.00(0.00,0.02),均P>0.05〕。ROC曲线分析显示,术后miR-1诊断冠脉斑块破裂的ROC曲线下面积(AUC)和95%可信区间(95%CI)为0.794(0.687~0.900),P<0.01,敏感度为82.8%,特异度为68.4%,最佳截断值为1.51;术前与术后miR-1差值(ΔmiR-1)诊断冠脉斑块破裂的AUC和95%CI为0.704(0.567~0.842),P=0.004,敏感度为62.1%,特异度为84.2%,最佳截断值为0.39;术后miR-1与ΔmiR-1诊断SCAD患者冠脉斑块破裂的能力相当(Z=1.287,P=0.198);而术前miR-1不能预测SCAD患者是否需要行PCI(AUC=0.630,P>0.05)。多因素二元Logistic回归分析显示,术后miR-1表达升高是SCAD患者发生冠脉斑块破裂的独立危险因素〔优势比(OR)=2.887,95%CI为1.044~7.978,P=0.041〕。结论循环miR-1可能具备早期Objective To evaluate the diagnostic value of circulating microRNA-1(miR-1)in early coronary artery plaque rupture in patients with stable coronary artery disease(SCAD).Methods A prospective cohort study was conducted.Sixty-seven patients with SCAD admitted to the department of cardiology of the Third Affiliated Hospital of Soochow University from January to June in 2019 were enrolled.All patients had completed coronary angiography(CAG),percutaneous coronary intervention(PCI)single stent implantation or only CAG was performed according to the CAG results.Blood samples were collected before(0 hour)and 3 hours after the procedure.The expression of plasma miR-1 was detected by real-time quantitative reverse transcription-polymerase chain reaction(RT-PCR),and electrocardiogram was used to detect cardiac troponin I(cTnI)levels.The difference of miR-1 and cTnI levels in PCI or CAG patients before and after procedure were compared,and the value for early diagnosis of coronary artery plaque rupture in SCAD patients was evaluated.The diagnostic efficacy was evaluated by the receiver operating characteristic curve(ROC curve).Results There were 38 CAG patients and 29 PCI patients.There were no significant differences in gender,age,previous history(without hypertension history)and baseline data of cardiac function between the two groups.The expression of miR-1 after PCI was significantly higher than that before PCI[2^(-ΔΔCt):2.11(1.56,2.73)vs.1.26(1.07,1.92),P<0.01],and there was no significant difference in cTnI level before and after PCI[μg/L:0.00(0.00,0.02)vs.0.00(0.00,0.02),P>0.05].There were no significant differences in miR-1 and cTnI levels before and after procedure in the CAG group[miR-1(2^(-ΔΔCt)):1.09(1.00,1.40)vs.1.21(1.00,1.71),cTnI(μg/L):0.00(0.00,0.02)vs.0.00(0.00,0.02),both P>0.05].ROC curve analysis showed that the area under ROC curve(AUC)and 95%confidence interval(95%CI)of miR-1 in the diagnosis of coronary plaque rupture were 0.794(0.687-0.900),P<0.01,the sensitivity was 82.8%,the specificity was 68

关 键 词：冠心病 心肌肌钙蛋白 微小RNA-1 斑块破裂 生物标志物 

分 类 号：R541.4[医药卫生—心血管疾病]