MicroRNA-126、...患者心肌损伤标志物的相关性_冀永红.pdf

中国现代医学杂志Vol.33 No.7Apr.2023第 33 卷 第 7 期2023 年 4 月China Journal of Modern MedicineMicroRNA-126、microRNA-328与急性非ST段抬高型心肌梗死患者心肌损伤标志物的相关性*冀永红，丁晓芳，高文辉，兰玉霞，韩雅香，张敏（宁夏医科大学总医院 心血管内科，宁夏 银川 750001）摘要：目的研究血清microRNA-126（miR-126）、microRNA-328（miR-328）与急性非ST段抬高型心肌梗死（NSTEMI）患者心肌损伤标志物的相关性。方法选取2021年1月2022年1月宁夏医科大学总医院收治的191例急性NSTEMI患者为观察组，另选取同期该院门诊体检健康的180例志愿者为对照组。比较两组的心肌损伤标志物 脑钠肽（BNP）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）、心肌肌钙蛋白I（cTnI）水平，以及miR-126、miR-328表达的差异。绘制受试者工作特征（ROC）曲线分析BNP、CK-MB、LDH、cTnI、miR-126、miR-328预测NSTEMI的价值。参照全球冠状动脉事件登记（GRACE）评分标准，将急性NSTEMI患者分为低危组、中危组及高危组，比较3组BNP、CK-MB、LDH、cTnI、miR-126、miR-328的差异。采用Pearson相关系数分析BNP、CK-MB、LDH、cTnI与miR-126、miR-328的相关性。结果观察组BNP、CK-MB、LDH、cTnI水平及miR-328 mRNA相对表达量高于对照组（P 0.05），miR-126 mRNA相对表达量低于对照组（P 0.05）。ROC曲线分析结果显示，BNP 1 149.684 ng/L、CK-MB 34.760 ng/mL、LDH 812.535 u/L、cTnI 3.583 g/L、miR-126 26.825、miR-328 1.215是NSTEMI的最佳截断值，敏感性分别为84.2%（95%CI：0.714，0.854）、84.7%（95%CI：0.723，0.921）、83.7%（95%CI：0.741，0.882）、67.9%（95%CI：0.595，0.789）、87.2%（95%CI：0.623，0.932）、77.9%（95%CI：0.745，0.836），特异性分别为 82.8%（95%CI：0.653，0.912）、83.9%（95%CI：0.675，0.931）、83.9%（95%CI：0.741，0.963）、74.4%（95%CI：0.628，0.844）、87.9%（95%CI：0.573，0.917）、82.8%（95%CI：0.749，0.901）。高危组BNP、CK-MB、LDH、cTnI水平及miR-328 mRNA相对表达量较低危组、中危组升高（P 0.05），miR-126 mRNA相对表达量较低危组、中危组降低（P 0.05）。Pearson相关性分析结果显示，miR-126与BNP、CK-MB、LDH、cTnI呈负相关（P 0.05），miR-328与BNP、CK-MB、LDH、cTnI呈正相关（P 0.05）。结论NSTEMI患者的BNP、CK-MB、LDH、cTnI水平及miR-126、miR-328 mRNA相对表达量与健康人群有差异，并随NSTEMI病情进展而变化。miR-126、miR-328与BNP、CK-MB、LDH、cTnI相关，提示miR-126、miR-328有望成为NSTEMI早期诊断的新型标志物。关键词：非ST段抬高型心肌梗死；microRNA-126；microRNA-328；心肌损伤标志物中图分类号：R542.2文献标识码：ACorrelation of microRNA-126 and microRNA-328 with myocardial injury marker levels in patients with acute non-ST-segmentelevation myocardial infarction*Ji Yong-hong,Ding Xiao-fang,Gao Wen-hui,Lan Yu-xia,Han Ya-xiang,Zhang Min(Department of Cardiology,General Hospital of Ningxia Medical University,Yinchuan,Ningxia 750001,China)心肌梗死专题 论著DOI:10.3969/j.issn.1005-8982.2023.07.002文章编号：1005-8982（2023）07-0007-08收稿日期：2022-12-20*基金项目：宁夏自然科学基金（No：2022AAC03577）通信作者 张敏，E-mail：；Tel：15209508518 7中国现代医学杂志第 33 卷 Abstract:Objective To study the relationship between serum microRNA-126(miR-126),serum microRNA-328(miR-328),and myocardial injury markers in patients with acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods A total of 191 NSTEMI patients admitted from January 2021 to January 2022 were selected as the observation group,and 180 healthy volunteers who underwent physical examination in outpatient department during the same period were selected as the control group.The levels of creatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnI),lactate dehydrogenase(LDH),brain natriuretic peptide(BNP),miR-126,and miR-328 were compared between the two groups.Under ROC analysis,the predictive value of BNP,CK-MB,LDH,cTnI,miR-126,and miR-328 for non-STEMI was determined.Non-stemi patients were divided into low-risk group,medium-risk group,and high-risk group according to global coronary event registry(GRACE score).The correlation of BNP,CK-MB,LDH,and cTnI wirh miR-126 and miR-328 was analyzed by Person correlation coefficient.Results Compared with the control group,BNP,CK-MB,LDH,cTnI and miR-328 in the observation group were higher than those in the control group,and miR-126 was lower than that in the control group(P 0.05).ROC analysis showed that BNP 1 149.684 ng/L,CK-MB 34.760 ng/mL,LDH 812.535 u/L,cTnI 3.583 g/L,miR-126 26.825,miR-328 1.215 were the best cut-off values for non-STEMI.The sensitivity was 84.2%(95%CI:0.714,0.854),84.7%(95%CI:0.723,0.921),83.7%(95%CI:0.741,0.882),67.9%(95%CI:0.595,0.789),87.2%(95%CI:0.623,0.932),and 77.9%(95%CI:0.745,0.836),and specificity was 82.8%(95%CI:0.653,0.912),83.9%(95%CI:0.675,0.931),83.9%(95%CI:0.741,0.963),74.4%(95%CI:0.628,0.844),87.9%(95%CI:0.573,0.917),and 82.8%(95%CI:0.749,0.901),respectively.There were significant differences in BNP,CK-MB,LDH,cTnI,miR-126 and miR-328 in patients with different severity of non-STEMI(P 0.05).Compared with the low-risk and medium-risk groups,the levels of BNP,CK-MB,LDH,cTnI,and miR-328 were higher and the levels of miR-126 were lower in the high-risk group(P 0.05).The correlation analysis showed that miR-126 was negatively correlated with BNP,CK-MB,LDH,and cTnI,while miR-328 was positively correlated with BNP,CK-MB,LDH,and cTnI(P 0.05），具有可比性（见表 1）。本研究经医院医学伦理委员会审批（批号：2019-15号），患者及志愿者签署知情同意书。1.2纳入与排除标准观察组符合 不稳定性心绞痛和非 ST 段抬高型心肌梗死诊断与治疗指南11的 NSTEMI 诊疗标准且经影像学证实，对照组于本院行健康体检且与观察组无血缘关系；观察组患者发病至入院 48 h，胸痛时间 30 min。排除标准：凝血功能异常；合并原发性心肌病或房颤；严重心律失常；免疫系统疾病；肝肾功能严重异常；合并恶性肿瘤；心脏手术史或移植史；年龄 75岁；非首次心肌梗死。1.3方法1.3.1 观察组患者分组 观察组患者入院后均行经皮冠状动脉介入治疗，依据全球急性冠状动脉事件 登 记（global registry of acute coronary events,GRACE）评分标准12，对年龄、心率、心功能分级、心肌损伤标志物水平、心电图 ST 改变等予以评分，分为低危组（GRACE 评分 140 分，n=52）。3 组的性别构成、病变部位、病变支数比较，差异无统计学意义（P 0.05），具有可比性。见表2。1.3.2 心肌损伤标志物水平检测 观察组于入院后即刻，对照组于当日清晨抽取静脉血8 mL。微流控荧光免疫法检测脑钠肽（brain natriuretic peptide,BNP），试剂盒购自荷兰NanoEntek公司，比色法测定乳酸脱氢酶（lactate dehydrogenase,LDH），试剂盒购自瑞士Roche Diagnostics公司，化学发光法检测肌酸激酶