【摘要】 目的 探讨血浆miR-146a/b及全身炎症指数（SIRI）对急性心肌梗死（AMI）的预测价值。方法 前瞻性选取2024年1～12月在蚌埠医科大学附属铜陵医院（铜陵市人民医院）胸痛中心住院治疗的32例动脉粥样硬化（AS）患者（AS组）、81例冠状动脉粥样硬化性心脏病患者（CAD组）、78例AMI患者（AMI组）以及100例健康体检人群（对照组）作为研究对象，分别采集患者乙二胺四乙酸二钾（EDTA-K₂）抗凝血液2 m L，采用荧光定量PCR检测血浆miR-146a/b含量，并收集血常规及高敏C反应蛋白（hsCRP）、血糖血脂指数，计算相关全身炎症指数等衍生参数。比较四组受检者的血常规、hsCRP、糖脂代谢参数、全身炎症指数及其他衍生指数和血浆miR-146a、miR-146b水平，采用受试者工作特征（ROC）曲线分析血常规、糖脂代谢及衍生参数对AMI的预测价值。结果 伴随着AS、CAD和AMI的病情逐步进展，miR-146a和miR-146b呈现为对照组<AS组<CAD组<AMI组，差异均有统计学意义（P<0.05）。与对照组比较，AS组患者的非高密度脂蛋白胆固醇（nonHDL-C）、单核细胞计数（MO）与HDL-C比（MHR）、血小板计数（PLT）与HDL-C比（PHR）、全身炎症指数（SIRI）、全身免疫炎症指数（SII）均升高，而淋巴细胞计数（LYM）、高密度脂蛋白胆固醇（HDL-C）降低，差异均有统计学意义（P<0.05）；与AS组比较，CAD组患者的总胆固醇（TCH）、低密度脂蛋白胆固醇（LDL-C）、nonHDL-C降低，甘油三酯（TG）、残余胆固醇（RC）、TG与HDL-C比（TG/HDL-C）升高，差异均有统计学意义（P<0.05）；与CAD组比较，AMI组患者的白细胞计数（WBC）、中性粒细胞计数（NEUT）、MO、hsCRP、血清葡萄糖（GLU）、TCH、LDL-C、nonHDL-C,NEUT与HDL-C比（NHR）、MHR、PHR、SIRI、SII均升高，差异均有统计学意义（P<0.05）。以CAD组为基础采用ROC曲线分析上述参数对AMI的预测价值，AUC大于0.80的项目有WBC、NEUT、SIRI、SII、NHR以及miR-146a、miR-146b。结论 血浆miR-146a/b及SIRI参与了从动脉粥样硬化到心肌梗死的全部进程，并对急性心肌梗死具有较高的预测价值。更多还原

【Abstract】 Objective To explore the predictive value of plasma mi R-146a/b and systemic inflammatory response index（SIRI） for acute myocardial infarction（AMI）. Methods A prospective study was conducted enrolling 32 patients with atherosclerosis（AS group）, 81 patients with coronary atherosclerotic heart disease（CAD group）, 78 patients with AMI（AMI group） hospitalized at the Chest Pain Center, Tongling Hospital Affiliated to Bengbu Medical University（Tongling People’s Hospital） from January to December 2024, along with 100 healthy individuals（control group）. Ethylenediaminetetraacetic acid dipotassium salt dihydrate（EDTA-K₂） anticoagulated blood（2 m L） was collected from each participant. Plasma levels of miR-146a/b were measured using fluorescence quantitative real-time PCR（q RT-PCR）. Routine blood tests, high-sensitivity C-reactive protein（hsCRP）, blood glucose and lipid parameters, as well as calculated SIRI and other derived parameters were also analyzed. The routine blood parameters, hsCRP, glucose and lipid metabolism parameters, SIRI, other derived indices, and plasma miR-146a/b levels were compared among the four groups. Receiver operating characteristic（ROC） curve analysis was performed to evaluate the predictive value of blood routine parameters, glucose and lipid metabolism parameters, and derived indices for AMI. Results As the disease progressed from AS to CAD and AMI, plasma levels of miR-146a and miR-146b followed the trend of control group<AS group<CAD group<AMI group; the differences were statistically significant（all P<0.05）. Compared with the control group, the AS group exhibited elevated non-high-density lipoprotein cholesterol（non-HDL-C）, monocyte count to HDL-C ratio（MHR）, platelet count to HDL-C ratio（PHR）, SIRI, and systemic immune-inflammatory index（SII）, while lymphocyte count（LYM） and high-density lipoprotein cholesterol（HDL-C） were decreased; the differences were statistically significant（all P<0.05）. Compared with the AS group, the CAD group showed reduced total cholesterol（TCH）, low-density lipoprotein cholesterol（LDL-C）, and non-HDL-C, but increased triglycerides（TG）, remnant cholesterol（RC）, and TG to HDL-C ratio（TG/HDL-C）; the differences were statistically significant（all P<0.05）. Compared with the CAD group, the AMI group demonstrated higher white blood cell count（WBC）, neutrophil count（NEUT）, monocyte count（MO）,hsCRP, serum glucose（GLU）, TCH, LDL-C, non-HDL-C, neutrophil-to-HDL-C ratio（NHR）, MHR, PHR, SIRI, and SII, the differences were statistically significant（all P<0.05）. ROC curve analysis based on the CAD group revealed that WBC, NEUT, SIRI, SII, NHR, miR-146a, and miR-146b had areas under the curve（AUC）>0.80 for predicting AMI.Conclusion Plasma miR-146a/band SIRI are involved in the entire progression from atherosclerosis to myocardial infarction and have relatively high predictive value for acute myocardial infarction.更多还原