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生存结果与ST段抬高型心肌梗死中游离循环DNA的水平相关。

Survival outcomes correlate with the level of cell-free circulating DNA in ST-elevation myocardial infarction.

作者信息

Chu Ai-Ai, Gao Han-Xiang, Wu Ting-Ting, Zhang Zheng

机构信息

Heart Center, The First Affiliated Hospital, Lanzhou University, Lanzhou, China.

Department of Cardiology, Gansu Provincial People's Hospital, Lanzhou, China.

出版信息

J Res Med Sci. 2024 Feb 23;29:8. doi: 10.4103/jrms.jrms_335_22. eCollection 2024.

Abstract

BACKGROUND

Myocardial infarction (MI) can lead to higher cellular damage, making cell-free DNA (cfDNA) a potential biomarker for assessing disease severity. The aim of this study is to evaluate survival predictions using cfDNA measurements and assess its correlation with MI.

MATERIALS AND METHODS

A direct fluorescence assay was employed to measure cfDNA content in the blood samples of participants. The inclusion criteria included patients who gave informed consent, suffering from ST-elevation myocardial infraction (STEMI) based on established diagnostic criteria (joint ESC/ACC guidelines), between the age of 18 and 80 years old, and had elevated troponin biomarker levels. The study included 150 patients diagnosed with STEMI and 50 healthy volunteers as controls. Serial monitoring of patients was conducted to track their postdisease status. The rate of change of cfDNA was calculated and daily measurements for 7 days were recorded.

RESULTS

Mean levels of cfDNA were found to be 5.93 times higher in patients with STEMI compared to healthy controls, providing clear evidence of a clinical correlation between cfDNA and STEMI. Patients were further categorized based on their survival status within a 90-day period. The study observed a strong predictive relationship between the rate of change of cfDNA during daily measurements and survival outcomes. To assess its predictive capability, a receiver operating characteristics (ROC) curve analysis was performed. The ROC analysis identified an optimal cutoff value of 2.50 for cfDNA, with a sensitivity of 81.5% and specificity of 74.0% in predicting disease outcomes.

CONCLUSION

This study demonstrates a robust association between cfDNA and STEMI, indicating that cfDNA levels can be a valuable early prognostic factor for patients. Serial measurements of cfDNA during early disease onset hold promise as an effective approach for predicting survival outcomes in MI patients.

摘要

背景

心肌梗死(MI)可导致更高程度的细胞损伤,使游离DNA(cfDNA)成为评估疾病严重程度的潜在生物标志物。本研究的目的是评估使用cfDNA测量进行生存预测,并评估其与MI的相关性。

材料与方法

采用直接荧光测定法测量参与者血样中的cfDNA含量。纳入标准包括签署知情同意书、根据既定诊断标准(欧洲心脏病学会/美国心脏病学会联合指南)患有ST段抬高型心肌梗死(STEMI)、年龄在18至80岁之间且肌钙蛋白生物标志物水平升高的患者。该研究纳入了150例诊断为STEMI的患者和50名健康志愿者作为对照。对患者进行连续监测以跟踪其疾病后的状态。计算cfDNA的变化率,并记录7天的每日测量值。

结果

发现STEMI患者的cfDNA平均水平比健康对照高5.93倍,这为cfDNA与STEMI之间的临床相关性提供了明确证据。根据患者在90天内的生存状态进一步进行分类。该研究观察到每日测量期间cfDNA的变化率与生存结果之间存在很强的预测关系。为了评估其预测能力,进行了受试者工作特征(ROC)曲线分析。ROC分析确定cfDNA的最佳截断值为2.50,在预测疾病结果时灵敏度为81.5%,特异性为74.0%。

结论

本研究证明了cfDNA与STEMI之间存在密切关联,表明cfDNA水平可能是患者重要的早期预后因素。在疾病早期对cfDNA进行连续测量有望成为预测MI患者生存结果的有效方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aed1/10956566/6a216f3e22af/JRMS-29-8-g001.jpg

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