【作者】 刘倩；

【导师】 芮涛；

【作者基本信息】 江苏大学 ， 内科学（专业学位）， 2017， 硕士

【摘要】 背景:急性心肌梗死(acute myocardial infarction,AMI)是心内科常见急症,是基于冠状动脉病变基础上,突发的冠状动脉血流骤然减少或突然中断,致使缺血部分冠脉所对应的心肌细胞发生严重、持久的缺血,进而造成局部心肌细胞的急性坏死。小脑变性相关蛋白1反义转录物(cerebellardegeneration-relatedprotein1antisense,CDR1as)是由人染色体X的反义链上的CDR1as基因外显子经反相剪切形成的环状RNA(circularRNA,circRNA)。经研究证实CDR1as在急性心肌梗死中有重要作用,但目前未见环状RNA-CDR1as与急性心肌梗死患者危险分层及梗死后早期室性心律失常关系的相关性研究。目的:初步探讨急性心肌梗死(AMI)患者外周循环血液中环状RNA-CDR1as与该患者危险分层及梗死后早期室性心率失常的关系。方法:选取我院2016年1月29日至2016年8月29日,以突发急性胸痛为主要症状入胸痛中心,经严格查体、心脏彩超、血液BNP尤其是心电图、心梗三项确诊为急性心肌梗死患者50例,分别于急诊冠状动脉支架植入术(PCI)术前、术后24h、术后48h抽取患者外周循环血液,为排除其他疾病影响选50名非急性心肌梗死患者作对照,并选取10例健康成人作空白对照,利用基因芯片技术检测外周血液中环状RNA作为筛选试验,以实时定量PCR行验证实验,与此同时对于入选患者进行严格而全面的急性冠脉事件评分(GRACE),并对入选患者行心电监护及完善术后24h动态心电图。结果:1.环状RNA-CDR1as在AMI组中较健康组有明显升高(P<0.05),且在疾病早期(PCI术前)即有升高,可稳定存在于术后48h(P<0.05);2.环状RNA水平与患者梗死后危险分层相关(P<0.05);3.环状RNA水平与患者梗死后室性心律失常明显相关性(P<0.05)。结论:环状RNA-CDR1as在急性心肌梗死患者发病早期即可升高,可稳定存在于术后48h,其水平与急性冠脉事件评分(GRACE)呈正相关,因此与患者预后可能具有密切关联。且环状RNA-CDR1as水平与患者梗死后早期室性心律失常相关性明显。更多还原

【Abstract】 Background:Acute myocardial infarction(AMI)is a common emergency in Department of cardiology,which is based on coronary artery lesion,caused by reduction or interruption of coronary blood flow,results in a severe and persistent ischemia of myocardial cells and then leads to acute necrosis of the local myocardial cells.The cerebellar degeneration-related protein 1 antisense(CDR1as),one of the human circular RNAs,formed by gene-CDR1as back-spliced which gene segment is form the antisense strand of human chromosome X.It has been proved that CDR1as plays an important role in acute myocardial infarction.However,there was no correlation study on the relationship of CDR1as and the risk stratification of patients with acute myocardial infarction or early ventricular arrhythmia after myocardial infarction.Objective:To evaluate the values of the relationship of Circular RNA-CDR1as and risk stratification in patients with acute myocardial infarction and ventricular arrhythmia after early myocardial infarction.Method:From January 2016.29 to August 2017.29 patients with acute myocardial infarction were chosen from the Chest pain center of our hospital,which had suddenly chest pain as the main symptom at the first time,examined by rigorous medical examination,blood BNP,echocardiography,especially EGG and Cardiac Markers which is in accordance with international diagnostic standard.Taking their peripheral blood at three different times,that was the time before the percutaneous coronary artery stent implantation(PCI)、Postoperative 24h and the time after the PCI for 48h.In order to avoid the influence of disease,50 patients with non acute myocardial infarction were selected.At the same time 10 healthy adults was selected and took their peripheral blood as control group.Detecting the CDR1as in peripheral blood by cDNA microarray.After the admission patients was thoroughly evaluated by the Global Registry of Acute Coronary Events(GRACE),what is the most important is improving their clinical examinations,especially 24 hours dynamic electrocardiogram.Results:1.CDR1 as in AMI group was significantly higher than the healthy and non-AMI control group(P<0.05),and it has increased in the early stage of the disease and expressed very stably in the postoperative 48h(P<0.05).2.There was a significant correlation between CDR1as and GRACE score(P<0.05).3.There was significant correlation between CDRlas and early ventricular arrhythmia after infarction(P<0.05).Conclution:CDR1as can increase in the early stage of AMI,which can be stable in the postoperative 48h,and its level is positively correlated with the acute GRACE score.So it may be closely related to the prognosis of patients.And there was significant correlation between the level of CDRlas and ventricular arrhythmia after early myocardial infarction.更多还原