CAJ | 학술논문

目的评价miR.-499对急性心肌梗死(AMI)的诊断价值.方法诊断准确性试验.收集2010年11月至2011年7月无锡市第二人民医院、滁州市第一人民医院AMI患者131例(46例ST段抬高的心肌梗死患者和85例非ST段抬高的心肌梗死患者)以及78例非AMI患者,同时选取60名健康体检者作为对照.收集胸痛疑似AMI患者就诊2h内的血浆.荧光定量PCR法检测血浆中miR-499的相对丰度,以受试者工作特征曲线(ROC)分析血浆miR-499对AMI的诊断价值,多参数logistic回归模型分析血浆miR-499与AMI的关系.结果 AMI患者血浆miR-499的循环阈值差值(ΔCT)为1.01 ±3.34,非AMI的胸痛患者miR-499的ΔCT为-2.76 ±2.90,健康对照组的ΔCT为-3.79±2.21,差异有统计学意义(x2=96.77,P＜0.01).血浆miR-499诊断AMI的曲线下面积(AUC)为0.80(95％可信区间:0.74 ～0.86),较就诊时的肌钙蛋白I(cTnI)(AUC =0.90,95％可信区间:0.86～0.94)偏低(P＜0.01).当血浆miR-499取值为0.18时,其诊断AMI的敏感度(95％可信区间)和特异度(95％可信区间)分别为0.69(0.61 ～0.77)和0.77(0.66 ～0.86).血浆miR-499与cTnI的相关系数为0.72(P ＜0.01).在校正了cTnI以后,血浆miR-499相对丰度＞0.18,仍然与AMI相关,其优势比(95％可信区间)为2.59(1.10～6.07).结论血浆miR-499是诊断AMI的有益标志物,可以提供cTnI以外的诊断信息,二者联合应用可能有助于提高AMI的诊断准确性.
목적 평개miR.-499대급성심기경사(AMI)적진단개치.방법 진단준학성시험.수집2010년11월지2011년7월무석시제이인민의원、저주시제일인민의원AMI환자131례(46례ST단태고적심기경사환자화85례비ST단태고적심기경사환자)이급78례비AMI환자,동시선취60명건강체검자작위대조.수집흉통의사AMI환자취진2h내적혈장.형광정량PCR법검측혈장중miR-499적상대봉도,이수시자공작특정곡선(ROC)분석혈장miR-499대AMI적진단개치,다삼수logistic회귀모형분석혈장miR-499여AMI적관계.결과 AMI환자혈장miR-499적순배역치차치(ΔCT)위1.01 ±3.34,비AMI적흉통환자miR-499적ΔCT위-2.76 ±2.90,건강대조조적ΔCT위-3.79±2.21,차이유통계학의의(x2=96.77,P＜0.01).혈장miR-499진단AMI적곡선하면적(AUC)위0.80(95％가신구간:0.74 ～0.86),교취진시적기개단백I(cTnI)(AUC =0.90,95％가신구간:0.86～0.94)편저(P＜0.01).당혈장miR-499취치위0.18시,기진단AMI적민감도(95％가신구간)화특이도(95％가신구간)분별위0.69(0.61 ～0.77)화0.77(0.66 ～0.86).혈장miR-499여cTnI적상관계수위0.72(P ＜0.01).재교정료cTnI이후,혈장miR-499상대봉도＞0.18,잉연여AMI상관,기우세비(95％가신구간)위2.59(1.10～6.07).결론 혈장miR-499시진단AMI적유익표지물,가이제공cTnI이외적진단신식,이자연합응용가능유조우제고AMI적진단준학성.
Objective To evaluate the diagnostic performance of plasma miR-499 in acute myocardial infarction (AMI) diagnosis.Methods Diagnostic accuracy test.The suspected AMI patients,who with chest pain for more than half an hour and been admitted in the Second People's Hospital of Wuxi and First People's Hospital of chuzhou during October 2010 and July 2011,were consecutively and prospectively enrolled in the present study.Sixty apparently healthy individuals were designed as healthy control.The plasma samples of the suspected AMI patients were collected within two hours after admission.The plasma miR-499 was determined by real time polymerase chain reaction (RT-PCR).The diagnostic performance of plasma miR-499 for AMI was estimated by receiver operating characteristic (ROC) curve analysis.The association between plasma miR-499 and AMI was analyzed by multivariable logistic model.The plasma miR-499 was determined and explained in blind fashion.Results Two hundred and nine suspected AMI patients,including 131 confirmed AMI patients (46 STEMI and 85 NSTEMI) and 78 AMI free patients were enrolled in the present study.The delta cycle threshold (ΔCT) was 1.01 ± 3.34 for AMI patients,-2.76 ± 2.90 for non-AMI patients and-3.79 ± 2.21 for healthy controls.The differences had statistical significance (x2 =96.77,P ＜ 0.01).The area under curve (AUC) of plasma miR-499 was 0.80 (95％ C I:0.74-0.86),lower than that of cardiac troponin Ⅰ (AUC =0.90,95％ CI:0.86-0.94) on admission (P ＜0.01).At the optimal cut-off of 0.18,the diagnostic sensitivity and specificity were 0.69 (95％ CI:0.61-0.77) and 0.77 (95％ CI:0.66-0.86),respectively.The coefficient of correlation between plasma miR-499 and cTnI was 0.72 (P ＜0.01).The odds ratio (OR) of plasma miR-499 ＞0.18 for AMI was 2.59 (95％ CI:1.10-6.07),after adjusted cTnI.Conclusions Plasma miR-499 is a useful biomarker for AMI diagnosis.It can provide additional diagnostic information beyond cTnI.Combination utility of plasma miR-499 and cTnI may improve the diagnostic accuracy for AMI.