急性心肌梗死患者血浆线粒体 DNA水平变化及临床意义

摘要

目的：观察急性心肌梗死（ AMI）患者血浆线粒体DNA（ mtDNA）水平变化，并探讨其临床意义。方法选取因AMI行PCI治疗者（AMI组）30例、稳定型心绞痛患者（SAP组）15例、健康体检者（健康对照组）15例。 AMI组于行急诊PCI术前及术后第3天采集静脉血，SAP组于出现典型胸痛12 h内采集静脉血，健康对照组于体检时采集静脉血。采用荧光实时定量PCR法检测血浆mtDNA。取AMI组PCI术前静脉血，检测心肌酶谱指标（ CK、CK-MB、LDH）。绘制受试者工作特征（ ROC）曲线，分析血浆mtDNA诊断AMI的灵敏性和特异性。结果 AMI组术前、术后血浆mtDNA分别为3．7659±2．7515、2．1990±1．7723，SAP组为1．9898±1．2396，健康对照组为0．9050±0．7790， AMI组术前血浆mtDNA高于术后（P＜0．05）及SAP组（P＜0．01）、健康对照组（P＜0．01）。 AMI患者血浆mtDNA水平与CK、CK-MB、LDH均呈正相关（r分别为0．8619、0．7567、0．5607，P均＜0．05）。 mtDNA诊断AMI的灵敏性、特异性分别为36．67％、96．67％。结论 AMI患者血浆mtDNA水平增高，血浆mtDNA可作为辅助诊断AMI的指标。%Objective To investigate the changes in levels of plasma mitochondrial DNA ( mtDNA) in patients with a-cute myocardial infarction ( AMI) and its clinical significance in the diagnosis of AMI .Methods Thirty AMI patients with PCI (AMI group), 15 patients with stable angina pectoris (SAP group) and 15 healthy controls (control group) were col-lected.Venous blood of the AMI group was collected just before emergency PCI and three days after PCI , while within 12 h of a typical chest pain in the SAP group , and on physical examination in the control group .Plasma was obtained after centrifugation, the plasma mtDNA level was measured by quantitative real-time PCR in each group.The venous blood from the AMI group was collected to detect the related biochemical indicators ( including CK , CK-MB, LDH) , and the relation-ships between mtDNA levels and myocardial enzyme spectrum indexes of the AMI patients were analyzed .We drew the re-ceiver-operating characteristic ( ROC) curve and analyzed the sensitivity and specificity of plasma mtDNA in the diagnosis of AMI.Results The expression of mtDNA in the AMI group before and after operation was 3.765 9 ±2.751 5 and 2.199 0 ±1.772 3, respectively;1.989 8 ±1.239 6 in the SAP group and 0.905 0 ±0.779 0 in the control group.The expres-sion of mtDNA in the AMI group before operation was higher than that after operation (P<0.05), SAP group (P<0.01) and the control group (P<0.01).There was a positive correlation between mtDNA expression and CK , CK-MB, LDH, respectively (r=0.8619, 0.7567 and 0.5607, respectively;P<0.05).The sensitivity and specificity of mtDNA in the diagnosis of AMI were 36.67% and 96.67%, respectively.Conclusion The mtDNA level is increased in AMI patients and has a high specificity to the diagnosis of AMI , which can be used as an auxiliary index for the diagnosis of AMI .