microRNA-133a对非ST抬高型急性心肌梗死老年患者的诊断价值

Diagnostic value of serum microRNA-133a in older patients with acute non ST-elevation myocardial infarction

目的：心电图改变及肌钙蛋白T（c Tn T）在非ST抬高型心肌梗死（NSTEMI）老年患者中的诊断价值有限,microRNA在心肌梗死病变过程中具有重要的调控作用。探讨microRNA-133a作为老年NSTEMI患者生物标志物的可能性。方法：选择2011年7月—2014年1月于北京市石景山医院重症监护室（CCU）就诊的年龄〉65岁患者59例,其中NSTEMI 28例（NSTEMI组）,无冠状动脉病变急性心力衰竭患者31例（急性心衰组）。另选择年龄大于65岁无心血管疾病的健康人33例为对照组。除常规c Tn T检测外,3组患者分别经RT-PCR检测血清microRNA-1,microRNA-21和microRNA-133a的表达,并且对microRNA和c Tn T表达进行相关分析。结果：与健康对照组相比,NSTEMI组microRNA-1,microRNA-21和microRNA-133a的表达显著增高,而与急性心衰组相比,microRNA-1和microRNA-133a表达均显著增高。而且在老年NSTEMI患者中,microRNA-133a具有和c Tn T一致的判断价值。此外,对c Tn T中度升高（0.03~0.10 ng/m L）的老年患者,microRNA-133a在NSTEMI与急性心衰的鉴别诊断中具有更高的准确性（ROC曲线下面积0.85对0.73,P〈0.05）。结论：microRNA-133a在老年NSTEMI患者中血清表达显著增高,在c Tn T中度升高的患者中具有重要的鉴别诊断价值。

Objective： Abstract Objective： The diagnostic value of electrocardiogram and cardiac troponin T（ c Tn T） elevation in geriatric patients（ 65 years old） patients with acute non ST- elevation myocardial infarction（ NSTEMI） always present are limited. And microRNA has key roles in the pathophysiology of acute myocardial infarction. To discusse whether microRNA- 133 a to be a potential biomarkers of patients with NSTEMI. Methods： Patients with a diagnosis of NSTEMI group（ n= 28）,acute heart failure with non coronary artery etiology group（ n = 31） and healthy control group（ n = 33） were enrolled in Shijingshan Hospital of Beijing from July 2011 to January 2014. Beside c Tn T,serum microRNA- 1,microRNA- 21 and microRNA- 133 a were detected by RT- PCR,and the correction between microRNA and c Tn T were analyzed. Results： Serum microRNA- 1,microRNA- 21 and microRNA- 133 a showed significant elevation in NSTEMI group compared with healthy control group. And only microRNA- 133 a showed significant increase in acute heart failure patients compared with healthy control group. In older patients with NSTEMI,microRNA- 133 a was comparable to c Tn T in discrimination NSTEMI compared with healthy control group. And in older patients with moderate elevation of serum c Tn T（ 0. 03 ~ 0. 10 ng / m L）,microRNA-133 a has a higher diagnostic accuracy than acute heart failure（ area under ROC curve 0. 85 vs 0. 73,P〈0. 05）. Conclusion：Serum microRNA- 133 a is significantly elevated in patients with NSTEMI,and it is a sensitive biomarker in diagnostic accuracy in modest c Tn T elevation patients.