急性心肌炎患者血浆外泌体miRNAs表达谱筛选及临床意义  

Screening and clinical significance of plasma exosomal miRNAs profile in acute myocarditis

作　　者：潘晓青 鱼军[1] 孙为[1] PAN Xiaoqing;YU Jun;SUN Wei(Department of Emergency,Xi'an Central Hospital,Xi'an 710043,Shaanxi,China)

机构地区：[1]西安市中心医院急诊科,陕西西安710043

出　　处：《中国分子心脏病学杂志》2025年第1期6608-6614,共7页Molecular Cardiology of China

基　　金：陕西省创新能力支撑计划-医学研究项目(23YXYJ0061)。

摘　　要：目的 探讨血浆外泌体miRNA作为急性心肌炎(acute myocarditis, AM)诊断的潜在生物标志物的可能性。方法 2016年8月至2023年3月采集107例AM患者和112例健康对照的外周血样本,同时检测心电图(electrocardiography, ECG)异常表现。各抽取10例血浆样本,使用下一代测序确定血浆外泌体miRNA表达谱。使用验证集样本(AM组97例,对照组102例),通过定量逆转录聚合酶链式反应(quantitative polymerase chain reaction, qPCR)进一步分析差异表达miRNA。受试者操作特征(receiver operating characteristic, ROC)曲线下面积(area under the curve, AUC)用于评估诊断的准确性。结果 在AM患者中,血浆exomiR-30a、exomiR-146a、exomiR-155被验证为显著差异表达的候选物,其中血浆exomiR-30a区分AM组和对照组的ROC曲线下面积>0.7,最佳临界值为1.12,可作为诊断AM的潜在标志物。逐步logistic回归模型分析结果显示,血浆exomiR-30a是显著的预测因子(P<0.001)。联合超敏心肌肌钙蛋白I(hypersensitive cardiac troponin I,hs-cTnI)和C反应蛋白(C-reactive protein, CRP)能够良好地区分AM组和对照组,AUC为0.826(95%CI:0.765,0.887)。按血浆exomiR-30a三分位对AM患者进行分层,高exomiR-30a(≥2.77)亚组患者ECG异常比例高于低exomiR-30a(<1.22)亚组和中等exomiR-30a(1.22~2.77)亚组(P=0.029)。结论 血浆exomiR-30a在区分AM方面表现出较高的准确性,可辅助hs-cTnI、CRP用于AM的诊断。此外,血浆exomiR-30a高表达与AM患者ECG异常有关,有助于AM的风险分层。Objective To explore the potential use of plasma exosomal miRNA as a biomarker for the diagnosis of acute myocarditis(AM). Methods Peripheral blood samples were collected from 107 AM patients and 112 healthy controls to detect abnormal electrocardiogram(ECG) manifestations. Extract 10 plasma samples each and use next-generation sequencing to determine the plasma exosomal miRNA profile. Using validation set samples(97 cases in AM group and 102 cases in control group), differential expression miRNAs were further analyzed by quantitative reverse transcription polymerase chain reaction. The area under the receiver operating characteristic(ROC) curve(AUC) is used to evaluate diagnostic accuracy. Results For AM patients, plasma exomiR-30a, exomiR-146a, and exomiR-155 were identified as candidates for significant differential expression. Among them, plasma exomiR-30a distinguished between AM and the control group, with an area under the ROC curve greater than 0.7 and an optimal critical value of 1.12, which could serve as potential biomarkers for the diagnosis of AM. In addition, through stepwise logistic regression model analysis, plasma exomiR-30a was a significant predictive factor(P<0.001). The combination of hypersensitive cardiac troponin I(hs-cTnI) and C-reactive protein(CRP) effectively distinguished the AM and control groups, with an AUC of 0.826(95%CI: 0.765-0.887). Finally, AM patients were stratified according to plasma exomiR-30a tripartite. Patients with high exomiR-30a(≥2.77) had a higher proportion of abnormal ECG than those with exomiR-30a(<1.22) and moderate exomiR-30a(1.22~2.77)(P=0.029). Conclusions Plasma exomiR-30a exhibits high accuracy in distinguishing AM from the control group, and can assist hs-cTnI and CRP in the diagnosis of AM. In addition, the high expression of exomiR-30a in plasma is associated with abnormal ECGin AM patients, which helps to stratify the risk of AM.

关 键 词：急性心肌炎 血浆外泌体 miRNA表达谱 生物标志物 心电图 

分 类 号：R542.2[医药卫生—心血管疾病]