急性冠脉综合征患者血浆微小RNA-130a表达水平及其临床意义

Expression level and clinical significance of plasma microRNA-130a in patients with acute coronary syndrome

目的探讨急性冠脉综合征(ACS)患者血浆微小RNA(miRNA)-130a水平及其临床意义。方法纳入101例ACS患者,包括不稳定性心绞痛(UA)组47例、急性心肌梗死(AMI)组54例,并选取20例健康者作为对照组。检测所有研究对象血浆miRNA-130a表达量及心肌酶指标。分析ACS患者临床指标与血浆miRNA-130a表达水平的相关性。采用受试者工作特征(ROC)曲线分析血浆miRNA-130a表达量对UA及AMI的诊断价值。结果对照组、UA组、AMI组miRNA-130a表达水平、肌酸激酶同工酶(CK-MB)、肌红蛋白、心肌肌钙蛋白I(cTnI)水平均依次升高(均P<0.05)。ACS患者的miRNA-130a表达量与HDL、左室射血分数均呈负相关,与CK-MB、肌红蛋白、cTnI、N-末端脑钠肽前体、总胆固醇、三酰甘油、超敏C反应蛋白、尿酸、纤维蛋白水平、冠状动脉Gensini评分均呈正相关(均P<0.05)。ROC曲线分析结果显示,miRNA-130a、cTnI、CK-MB、Gensini评分诊断UA的曲线下面积分别为0.982、0.352、0.650、0.955,miRNA-130a的诊断灵敏度、特异度与Gensini评分相似,均高于cTnI、CK-MB;miRNA-130a、cTnI、CK-MB、Gensini评分诊断AMI的曲线下面积分别为1.000、0.948、0.859、0.991,miRNA-130a的诊断灵敏度、特异度与Gensini评分相似,特异度低于cTnI。结论AMI及UA患者血浆miRNA-130a表达水平上调,对AMI及UA有较高的诊断效能,或可为ACS的分型提供重要依据。

Objective To explore the level and clinical significance of plasma microRNA(miRNA)-130a in patients with acute coronary syndrome(ACS).Methods A total of 101 ACS patients were enrolled,including 47 in the unstable angina(UA)group and 54 in the acute myocardial infarction(AMI)group,concurrently,20 healthy individuals were selected as control group.Plasma miRNA-130a expression and myocardial enzyme indicators were detected in all subjects.The correlation between clinical indicators and plasma miRNA-130a expression level was analyzed in ACS patients.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of plasma miRNA-130a expression for UA or AMI.Results Relative expression level of miRNA-130a,as well as the levels of creatinine kinase,MB isoenzyme(CK-MB),myoglobin and cardiac troponin I(cTnI)increased in turn in the control group,the UA group and the AMI group(P<0.05).Among ACS patients miRNA-130a expression negatively correlated with HDL or left ventricular ejection fraction,and positively correlated with CK-MB,moglobin,cTnI,N-terminal pro-brain natriuretic peptide,total cholesterol,triglyceride,high-sensitivity C-reactive protein,urea nitrogen,fibrinogen levels,and coronary Gensini score(all P<0.05).ROC curve analysis results revealed that the areas under the curve of miRNA-130a,cTnI,CK-MB,and Gensini score for diagnosing UA were 0.982,0.352,0.650,and 0.955,respectively,miRNA-130a was similar to Gensini score in diagnostic sensitivity and specificity,exhibiting higher diagnostic sensitivity and specificity than cTnI or CK-MB;the areas under the curve of miRNA-130a,cTnI,CK-MB,and Gensini score for diagnosing AMI were 1.000,0.948,0.859,and 0.991,respectively,miRNA-130a was similar to Gensini score in diagnostic sensitivity and specificity,showing a lower specificity than cTnI.Conclusions Plasma miRNA-130a expression level is elevated in patients with AMI or UA,which has higher diagnostic efficiency for AMI or UA,and may provide important evidences for ACS classification.