目的 · 评估血清 miRNA 用于急性冠脉综合征（ACS）早期诊断的潜在价值。方法 · 急诊入院的 28 例疑似 ACS 患者，在 3 h 内采集血液样本；根据ACS 诊疗指南，最终将患者分为ACS 组（18 例）和非ACS 组（10 例）。采用qRT-PCR 技术检测心肌特异 性 miR-499 以及与心肌损伤密切相关的 miR-652 的含量，同时监测肌钙蛋白 I（cTnI）变化，分析 miRNA 和 cTnI 之间的相关性，并 采用95% 界值建立医学参考值范围。结果 · 研究对象急诊入院3 h 内，ACS 患者的血清中已检测到miRNA 的升高；并且ACS 组 患者血清miR-499 的表达水平为非ACS 组的9.2 倍（P=0.009）。 miR-499（r=0.595，P=0.001）和miR-652（r=0.579，P=0.001）均 与 cTnI 呈显著正相关；miR-499 和 miR-652 的 ROC 曲线下面积（AUC）分别为0.786 和 0.583；miR-499 的敏感度与特异度分别为 72.22% 和 80.00%，miR-652 则为72.22% 和 60.00%；miR-499 和 miR-652 医学参考值范围分别为0.001 ～ 2.723 和 0.122 ～ 9.660。
 结论 · 血清中的心肌特异性 miR-499 有望成为 ACS 早期诊断的生物标志物。

Objective · To investigate the potential value of serum miRNAs for early diagnosis of acute coronary syndrome (ACS).  Methods · Blood samples were collected from 28 emergency patients with suspected ACS in 3 h after enrollment. Eighteen patients were finally diagnosed as ACS and ten as nonACS according to the ACS guideline. The expression levels of cardiac miR-499 and myocardial injury related miR-652 were measured with qRT-PCR. At the same time levels of troponin I (cTnI) were monitored. Then the correlations between miRNAs and cTnI were analyzed. In addition, 95% reference range was established.  Results · The expression levels of serum miRNAs increased in ACS patients within 3 h and serum miR-499 in the ACS patients was 9.2 times the amount in the non-ACS patients (P=0.009). Serum miR-499 (r=0.595, P=0.001) and miR-652 (r=0.579, P=0.001) levels both had positive correlations with cTnI. The area under the ROC curve (AUC) of serum miR-499 and miR-652 was 0.786 and 0.583, respectively. The sensitivity and specificity of miR-499 were 72.22% and 80.00%, respectively, while 72.22% and 60.00% for miR-652. The reference ranges of serum miR-499 and miR-652 were 0.001-2.723 and 0.122-9.660, respectively.  Conclusion · Cardiac miR-499 in serum has potential to be a biomarker for early diagnosis of ACS.