循环血外泌体miR-320对NSTEMI的鉴别诊断价值研究

Value of circulating blood exosomal miR-320 in differential diagnosis of NSTEMI

目的探讨循环血外泌体miR-320对非ST段抬高心肌梗死(NSTEMI)的鉴别诊断价值。方法连续纳入2017年1月~2019年7月医院收治的NSTEMI患者112例作为观察组训练集,同期纳入非心肌梗死患者37例作为对照组,纳入2019年8月~2020年12月医院收治的NSTEMI患者75例作为观察组测试集,同期纳入非心肌梗死患者21例作为对照组,提取两组患者外周血外泌体并通过实时荧光定量PCR检测miR-320表达水平,使用皮尔逊线性相关分析miR-320表达和高敏心肌肌钙蛋白(hs-TnI)水平的相关性;使用受试者工作特征曲线(ROC)及其曲线下面积(AUC)评估其诊断效能。结果观察组miR-320表达量与hs-TnI水平相关系数为0.831(95%可信区间0.782~0.871,P<0.001),对照组miR-320表达量与hs-TnI水平相关系数为 0.383 (95%可信区间 0.138~0.583,P<0.01);miR-320 诊断 NSTEMI 的 AUC值为 0.899 (95%可信区间 0.839~0.943),高于hs-cTnI的0.739(95%可信区间0.661~0.808),差异有统计学意义(Z=3.100,P<0.01),根据ROC曲线确定的miR-320和hs-cTnI最佳灵敏度和特异度下截断值分别为1.14和0.18 ng/ml,测试集中miR-320诊断NSTEMI的灵敏度、特异度、阳性似然比、阴性似然比及正确指数分别为73.3%、90.5%、7.70、0.29、0.64。结论循环血外泌体miR-320能有效区分NSTEMI与病毒性心肌炎和急性肺栓塞患者,对NSTEMI的鉴别诊断有较好应用前景。

Objective To explore the value of circulating blood exosomal miR-320 in differential diagnosis of non-ST-segment elevation myocardial infarction(NSTEMI).Methods A total of 112 patients with NSTEMI admitted to our hospital from January 2017 to July 2019 were continuously included as the training set of the observation group,and 37 non-myocardial infarction patients were included in the same period as the control group.A total of 75 patients with NSTEMI admitted to our hospital from August 2019 to December 2020 were included as the test set of the observation group,and 21 non-myocardial infarction patients were included in the same period as the control group.The peripheral blood exosomes of the two groups were extracted,miR-320 expression level was detected by real-time fluorescent quantitative PCR,and the correlation between miR-320 expression and high-sensitivity cardiac troponin(hs-TnI) level was analyzed by Pearson linear correlation analysis.The diagnostic efficiency of miR-320 was evaluated according to the receiver operating characteristic curve(ROC) and its area under the curve(AUC).Results The correlation coefficient between miR-320 expression and hs-TnI level was 0.831(95% CI 0.782-0.871,P <0.01) in the observation group and0.383(95% CI0.138-0.583,P <0.01) in the control group.The AUC value of miR-320 in diagnosing NSTEMI was 0.899(95% CI0.839-0.943),higher than 0.739(95% CI 0.661-0.808) of hs-cTnI,and the difference was statistically significant(Z=3.100,P <0.01).The cutoff values for the optimal sensitivity and specificity of miR-320 and hs-cTnI determined according to the ROC curve were 1.14 and 0.18 ng/ml,respectively.The sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,and correct index of miR-320 in diagnosing NSTEMI in the test set were 73.3%,90.5%,7.70,0.29 and 0.64,respectively.Conclusion Circulating blood exosomal miR-320 can effectively distinguish NSTEMI from viral myocarditis and acute pulmonary embolism,and has a good application prospect in the differential diagnosis of NSTEMI.