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临床输血与检验

临床输血与检验 ›› 2019, Vol. 21 ›› Issue (3): 308-312.DOI: 10.3969/j.issn.1671-2587.2019.03.023

• 临床检验 • 上一篇    下一篇

动态监测外周血CPNE3对急性心肌梗死的诊断价值

饶楚炳   

  1. 442008 十堰，湖北医药学院附属东风医院急救医学部
  • 收稿日期:2018-02-01 出版日期:2019-06-20 发布日期:2019-06-17
  • 作者简介:饶楚炳（1975-）,男,湖北郧西人,主治医师,主要从事急诊及危重症研究工作,（Tel）13387146152（E-mail）raochubing1975@163.com。

A Value of Dynamic Monitoring of CPNE3 in the Diagnosis of Acute Myocardial Infarction

RAO Chu-bing   

  1. Department of Emergency Medicine,Dongfeng Hospital of Hubei Medical University,Shiyan 442008
  • Received:2018-02-01 Online:2019-06-20 Published:2019-06-17

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摘要： 目的 动态监测急性心肌梗死（AMI）患者外周血CPNE3基因表达,探讨其对AMI的早期诊断价值。方法 将2016年7月~2017年7月于本院就诊的154例胸痛患者,按照AMI诊断标准分为AMI组48例和非AMI组106例,另选择60例健康人群作为对照组。AMI组分别于入院即刻、入院后4 h、6 h、12 h、24 h采集肘静脉血,非AMI组和对照组于入组时抽取静脉血,采用胶乳增强免疫比浊法检测血清cTnI浓度,电化学发光法检测血清CK-MB含量,实时荧光定量PCR检测外周血CPNE3 mRNA相对表达量; 利用受试者工作曲线（ROC）计算CPNE3 mRNA表达对AMI的早期诊断效能。结果 与非AMI组和对照组比较,AMI组的吸烟比例、高血压和糖尿病发病率增加,TC、TG、LDL-C、CK-MB、cTnI升高,HDL-C降低,差异有统计学意义（P﹤0.05）。入院即刻AMI组外周血CPNE3 mRNA表达明显低于非AMI组和对照组（P﹤0.05）,非AMI组和对照组CPNE3 mRNA表达的差异无统计学意义（P﹥0.05）。cTnI入院后6 h达峰值,CK-MB在患者入院后12 h达峰值,CPNE3 mRNA在入院后4 h降至最低值; 与入院即刻比较,入院后各时段AMI组cTnI、CK-MB明显升高,CPNE3 mRNA明显降低,差异有统计学意义（P﹤0.05）。CPNE3 mRNA表达与cTnI呈负相关（r=-0.198,P=0.016）,CPNE3 mRNA表达与CK-MB也呈负相关（r=-0.227,P=0.029）。ROC曲线分析显示,CPNE3诊断AMI的ROC曲线下面积（AUC）为0.910,敏感度为97.9%,特异度为75.0%; cTnI 的AUC 为0.801,敏感度为68.7%,特异度为89.6%; CK-MB 的AUC 为0.912,敏感度为75.0%,特异度为95.8%。结论 CPNE3可作为早期诊断AMI的指标,其诊断效能优于cTnI,与CK-MB相当。实时荧光定量PCR检测外周血CPNE3时间短,可满足临床急诊需求。

关键词: CPNE3基因, 心肌肌钙蛋白, I, 肌酸激酶同工酶, 急性心肌梗死, 诊断

Abstract: Objective To detect the circulating CPNE3 mRNA in the patients with acute myocardial infarction for evaluation of its diagnostic potential. Methods A total of 154 patients who were suffering from chest pain were admitted to the hospital. The patients were divided into AMI group （48 cases） and non-AMI group （106 cases） according to the diagnostic criteria. Sixty healthy persons were taken as control. Vein blood of AMI patients was collected immediately on admission and 4h,6h,12h,24h after admission. The level of serum cTnI was detected by Latex particle-enhanced turbidimetric immunoassay and serum cTnI,by electrochemiluminescence. The circulating CPNE3 mRNAs were examined by qRT-PCR. Results Compared to the non-AMI or the control,AMI mostly occurred in the individuals of smoking,hypertension and diabetes with a high level of TC,TG,LDL-C,CK-MB,and cTnI and a low level of HDL-C （P﹤0.05）. The CPNE3 mRNA in the AMI patients was significantly elevated （P﹤0.05） on immediate admission but greatly reduced at 4h after admission and no significant difference was noted between the non-AMI group and the control （P﹥0.05）. The level of cTnI reached peak value at 6h after admission and CK-MB,at 12h after admission. The cTnI and CK-MB increased and CPNE3 mRNA remarkably decreased in AMI patients at different stages of admission （P﹤0.05）. ROC curve analysis showed that the area under ROC curve （AUC） for the diagnostic value of CPNE3 mRNA on AMI was 0.910,with the sensitivity and specificity of 97.9% and 75.0%,respectively. The AUC for cTnI was 0.801,with the sensitivity and specificity of 68.7% and 89.6%. The AUC for CK-MB was 0.912,with the sensitivity and specificity of 75.0% and 95.8%. Conclusion The circulating CPNE3 mRNA has the potential in early diagnosis of AMI,which may be superior or equal to cTnI or CK-MB.

Key words: CPNE3 mRNA, Cardiactroponin I, Creatine kinase isoenzyme, Acute myocardial infarction, Diagnosis

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