循环血ANRIL在急性心肌梗死早期诊断中的价值

The value of circulating blood ANRIL in the early diagnosis of acute myocardial infarction

目的探讨循环血ANRIL在急性心肌梗死(AMI)早期诊断中的价值。方法收集2016年11月~2018年6月于广西医科大学附属民族医院(以下简称“我院”)收治的50例AMI患者(实验组)和30例冠脉造影正常者(对照组)的全血标本,采用实时荧光定量PCR(qRT-PCR)在AMI症状发作后的不同时间段(0~6 h、12 h、24 h、7 d和14 d)检测受试者循环血ANRIL水平,电化学发光法检测血浆肌钙蛋白T(cTnT)水平。结果两组年龄、性别、吸烟、糖尿病、低密度脂蛋白胆固醇(LDL-C)、收缩压、舒张压、血肌酐(Cr)比较差异均无统计学意义(P>0.05)。两组cTnT水平比较,差异有统计学意义(P<0.05)。与对照组比较,实验组血浆中循环ANRIL和cTnT表达水平明显升高,差异有统计学意义(P<0.05)。实验组循环血ANRIL表达水平在入院时即开始升高,在12 h达峰值之后有所下降,7 d时已降至正常范围;cTnT具有相当长的诊断窗口期,在6~12 h开始显著上升,24 h达峰值后有所下降,14 d时降至正常范围。受试者工作特征曲线(ROC)分析表明,当6 h时ANRIL表达值为正常对照的3.65倍(最高值)时,其敏感性为91.9%,特异性为91.1%,为最佳诊断节点;而cTnT值上升至24 h(最高值)时,诊断AMI的敏感性为91.8%,特异性可高达92.4%。结论AMI患者循环血ANRIL的表达明显升高,并随着病程而动态改变,与cTnT比较具有更早的时间窗和达峰时间,具备早期诊断AMI的可行性,但敏感性和特异性并不明显优于cTnT。

Objective To investigate the value of circulating ANRIL in the early diagnosis of acute myocardial infarction(AMI).Methods Blood samples were collected from 50 AMI patients(experimental group)and 30 patients with coronary angiography normally(control group)from November 2016 to June 2018 in Affiliated Ethnic Hospital of Guangxi Medical University(hereinafter referred to as“our hospital”).Quantitative real-time fluorescence polymerase chain reaction(qRT-PCR)was used to detect the levels of circulating ANRIL at different time intervals(0-6 h,12 h,24 h,7 d and 14 d)after the onset of symptoms of AMI.And the level of plasma cTnT was detected by using electrochemiluminescence.Results There was no significant difference in age,gender,smoking,diabetes,LDL-C,SBP,DBP and Cr between two groups(P>0.05).There was significant difference in cTnT between two groups(P<0.05).Compared with control group,the expression level of ANRIL and cTnT in the plasma of AMI patients increased significantly(P<0.05).In experimental group,the expression level of ANRIL began to increase at the time of admission,decreased after reaching the peak at 12 h,and decreased to the normal range at 7 d.CTnT had a very long diagnostic window period,it started to rise significantly at 6-12 h,then decreased at 24 h,and falled to the normal range at 14 d.ROC analysis showed that when the expression value of ANRIL in 6 h was 3.65 times(the highest value)of the normal control,the sensitivity was 91.9%,the specificity was 91.1%,which was the best diagnostic node;when the cTnT value increased to the highest value of 24 h,the sensitivity and specificity of AMI diagnosis was 91.8%,92.4%respectively.Conclusion The expression of circulating ANRIL in AMI patients increases significantly and changes dynamically with the course of disease.Compared with cTnT,circulating ANRIL has earlier time window and peak time.It has good early sensitivity and specificity for the diagnosis of AMI.