血清CysC及NHE1 mRNA水平检测在心力衰竭诊断中的临床应用
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摘要
目的探讨血清CysC(cystatin C,CysC)和血浆钠氢交换体1(sodium-hydrogen exchanger 1,NHE1)mRNA水平二者联合检测在心力衰竭(heartfailure,HF)早期诊断中的临床意义。方法血清CysC用ELISA检测,血浆NHE1 mRNA用荧光定量PCR检测。检测97例明确诊断为HF患者(病例组I),40例经诊断未有HF的冠心病、高血压等其他患者(病例组II),45例健康体检人群(对照组)的CysC及NHE1 mRNA的水平。分析三组受试者的血液中CysC及NHE1 mRNA水平差异,及两项指标联合检测的诊断心衰的临床价值。结果病例I组中血清CysC水平及血浆NHE1 mRNA水平分别为1.67±0. 27mg/L和1. 38±0. 21,病例II组CysC水平及NHE1 mRNA水平分别为1.25±0.28mg/L和1.09±0.19,对照组CysC水平及NHE1 mRNA水平分别为0.89±0. 1Omg/L和0.89±0.25,各组两两比较差异均有统计学意义(P均<0.05);联合检测平行(并联)试验对心力衰竭诊断的灵敏度和特异性分别为94. 85%和87.06%,优于单独检测CysC指标的灵敏度(88.66%)和特异性(91.76%)或NHE1 mRNA指标的灵敏度(63.92%)和特异性(95.29%)。结论联合检测CysC和NHE1 mRNA对心力衰竭的早期筛查和诊断具有一定的临床应用价值。
Objective To investigate the clinical significance of combined detection of serum Cystatin C(CysC) level and plasma sodium-hydrogen exchanger 1(NHE1)mRNA level in the early diagnosis of heart failure(HF). Methods Serum CysC was detected by ELISA and plasma NHE1 mRNA was detected by realtime PCR. 97 cases were diagnosed as the HF patients(the case group I), while 40 patients were diagnosed without HF but with coronary heart disease and hypertension(case group II),and 45 healthy subjects were also selected(control group). The CysC and NHE1 mRNA concentration were measured in all three groups.The differences in the levels of CysC and NHE1 mRNA in the blood of the three groups were analyzed,and the clinical value of the combined detection of two indicators in the diagnosis of heart failure was also analyzed. Results The levels of serum CysC and plasma NHEl mRNA in group I were 1.67 ±0. 27 mg/L and 1.38 ±0.21,respectively,and the levels of CysC and NHEl mRNA in group II were 1.25 ±0.28 mg/L,and 1.09 ±0.19,respectively. The levels of CysC and NHE1 mRNA in the control group were 0. 89 ±0.10 mg/L and 0. 89 ± 0. 25,respectively. There were significant differences between the two groups(P <0· 05).The sensitivity and specificity of the parallel combining test for the diagnosis of heart failure were 94.85%and 87.06%,respectively,which was better than the sensitivity(88. 66%) and specificity(91.76%) of the CysC index alone or the sensitivity(63.92%) and specificity(95.29%) of NHE1 mRNA alone. Conclusion Combined detection of CysC and NHE1 mRNA has certain clinical value in early screening and diagnosis of heart failure.
Objective To investigate the clinical significance of combined detection of serum Cystatin C(CysC) level and plasma sodium-hydrogen exchanger 1(NHE1)mRNA level in the early diagnosis of heart failure(HF). Methods Serum CysC was detected by ELISA and plasma NHE1 mRNA was detected by realtime PCR. 97 cases were diagnosed as the HF patients(the case group I), while 40 patients were diagnosed without HF but with coronary heart disease and hypertension(case group II),and 45 healthy subjects were also selected(control group). The CysC and NHE1 mRNA concentration were measured in all three groups.The differences in the levels of CysC and NHE1 mRNA in the blood of the three groups were analyzed,and the clinical value of the combined detection of two indicators in the diagnosis of heart failure was also analyzed. Results The levels of serum CysC and plasma NHEl mRNA in group I were 1.67 ±0. 27 mg/L and 1.38 ±0.21,respectively,and the levels of CysC and NHEl mRNA in group II were 1.25 ±0.28 mg/L,and 1.09 ±0.19,respectively. The levels of CysC and NHE1 mRNA in the control group were 0. 89 ±0.10 mg/L and 0. 89 ± 0. 25,respectively. There were significant differences between the two groups(P <0· 05).The sensitivity and specificity of the parallel combining test for the diagnosis of heart failure were 94.85%and 87.06%,respectively,which was better than the sensitivity(88. 66%) and specificity(91.76%) of the CysC index alone or the sensitivity(63.92%) and specificity(95.29%) of NHE1 mRNA alone. Conclusion Combined detection of CysC and NHE1 mRNA has certain clinical value in early screening and diagnosis of heart failure.
引文
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[21]胡从智.钠氢交换体NHE1在高盐诱导血管平滑肌细胞增殖和钙离子调控中的作用[D].遵义医学院,2016.
[22]金振晓,辛梅,陈涛,等.NHE1在心肌肥大,心肌纤维化和心衰中的作用[J].临床与病理杂志,2005,25(6):536-538.
[23]魏玲,徐家相,石家冲,等.心衰患者心肌中NHE1 mRNA的表达与血浆内皮素及心肌胶原的相关性研究[J].心脏杂志,2011,23(3):340-343,350.
[24]魏玲,石家冲,石云,等.心衰患者心肌组织中钠氢交换体1mRNA的表达与血清胶原的相关性研究[J].西南国防医药,2010,20(8):827-829.
[2]曹剑.心力衰竭最新诊治进展[J].中华保健医学杂志,2017,19(5):375-378.
[3]邱伯雍,王永霞.慢性心力衰竭流行病学及防治研究进展[J].中华实用诊断与治疗杂志,2017,31(6):619-621.
[4]苗利辉,赵丽.急性心力衰竭诊疗新进展[J].中国急救复苏与灾害医学杂志,2017,12(3):280-284.
[5]薛载耀,司全金.心力衰竭的诊断与治疗研究进展[J].中国临床保健杂志,2017,20(3):321-325.
[6]胡盛寿.心力衰竭外科治疗现状与进展[J].中国循环杂志,2016,31(3):209-213.
[7]刘继轩,赵晓静,贾倩,等.心力衰竭的生物标记物研究进展[J].解放军医学院学报,2017,38(12):1174-1177.
[8]宿宁,万新红,罗玉梅,等.心力衰竭治疗研究进展[J].医学综述,2017,23(10):1954-1957.
[9]郑刚.心力衰竭发病机制研究新进展[J].中华老年心脑血管病杂志,2018,20(4):428-431.
[10]韩额尔徳木图,马月宏,王海燕,等.慢性心衰的病理生理及发病机制研究进展[J].中西医结合心脑血管病杂志,2016,14(12):1349-1352.
[11]王宇朋,王萍,李虹伟.老年急性心力衰竭的研究进展[J].中华老年心脑血管病杂志,2017,19(12):1342-1344.
[12]韩科强,李秀,刘巍,等.舒张性心力衰竭的机制和治疗新进展[J].医学研究杂志,2016,45(8):156-158.
[13]姜胜伟,陆长亮.心内科常见病心力衰竭的诊断与治疗分析[J].中国卫生标准管理,2016,7(23):90-91,
[14]李连江.慢性心力衰竭诊断与治疗进展[J].中西医结合心血管病电子杂志,2017,5(22):20.
[15]黄洁,刘国红,杨海英.血清CA125与慢性心力衰竭严重程度及近期预后相关性分析[J].标记免疫分析与临床,2017,24(7):754-758.
[16]詹茂芹.血清CysC水平检测在急性心力衰竭诊断中的应用研究[J].河北医学,2018,24(5):848-851.
[17]殷和,王琼,巩婷,等.血清CysC测定在心力衰竭患者预后状况判定中的临床意义研究[J].中国实验诊断学,2016,20(3):437-438.
[18]冯静,康琳,刘勇,等.血清CysC水平检测在急性心力衰竭预后评估中的应用[J].临床合理用药杂志,2014,7(25):83-84.
[19]石家冲,魏玲,Shijia-Chong,等.钠氢交换体1与心血管疾病关系研究进展[J].医学综述,2008,14(24):3710-3712.
[20]苗茜,闵苏.钠/氢离子交换抑制剂心保护研究进展[J].中国体外循环杂志.2005,3(1):54-56.
[21]胡从智.钠氢交换体NHE1在高盐诱导血管平滑肌细胞增殖和钙离子调控中的作用[D].遵义医学院,2016.
[22]金振晓,辛梅,陈涛,等.NHE1在心肌肥大,心肌纤维化和心衰中的作用[J].临床与病理杂志,2005,25(6):536-538.
[23]魏玲,徐家相,石家冲,等.心衰患者心肌中NHE1 mRNA的表达与血浆内皮素及心肌胶原的相关性研究[J].心脏杂志,2011,23(3):340-343,350.
[24]魏玲,石家冲,石云,等.心衰患者心肌组织中钠氢交换体1mRNA的表达与血清胶原的相关性研究[J].西南国防医药,2010,20(8):827-829.