目的·探讨急性冠脉综合征（acute coronary syndrome，ACS）患者血清中miR-499表达水平对冠状动脉病变严重程度的预测价值。方法·纳入就诊于上海交通大学医学院附属新华医院的ACS患者74例，根据Gensini评分将患者分为轻度组（30例）、中度组（21例）及重度组（23例）。荧光实时定量聚合酶链反应（real-time quantitative polymerase chain reaction，qPCR）技术检测血清miR-499的表达量，同时检测肌钙蛋白（cTnI）、肌酸激酶同工酶（CK-MB）、肌红蛋白（Mb）、脑钠肽（BNP）、左心室射血分数（LVEF）等实验室指标。采用Spearman相关分析评估miR-499表达水平与Gensini 评分、冠状动脉病变血管支数的相关性。受试者操作特征（receiver operating characteristic，ROC）曲线分析miR-499对冠状动脉病变严重程度的评估价值。结果·miR-499的表达水平随着冠状动脉病变程度的加重呈上升趋势，组间差异有统计学意义（P=0.000）。miR-499表达水平与Gensini 评分、cTnI水平呈正相关（r值分别为0.331、0.143，P<0.05），与LVEF无相关性（P>0.05）；Gensini评分与cTnI、LVEF均无相关性（P>0.05）。ROC曲线分析结果显示，miR-499评估冠状动脉病变严重程度的AUC为0.802（95%CI 0.698~0.906），灵敏度为65.2%，特异度为80.4%。miR-499表达水平随着冠状动脉病变支数的增多呈升高趋势，且与冠状动脉病变支数呈正相关（r=0.368，P<0.05）。结论·ACS患者血清中miR-499表达水平与冠状动脉病变严重程度及病变支数相关，对冠状动脉病变严重程度具有一定评估价值。

Objective ·To explore the value of miR-499 expression levels in the serum of patients with acute coronary syndrome (ACS) in predicting the severity of coronary artery disease. Methods ·Seventy-four patients with ACS admitted to Xinhua Hospital, Shanghai Jiao Tong University School of Medicine were included and divided into a mild group of 30 cases, a moderate group of 21 cases, and a severe group of 23 cases according to the Gensini score. Real-time quantitative polymerase chain reaction (qPCR) technology was used to detect the expression level of serum miR-499, while troponin (cTnI), creatine kinase isoenzyme (CK-MB), myoglobin (Mb), brain natriuretic peptide (BNP), left ventricular ejection fraction (LVEF), and other laboratory indicators were measured. Spearman correlation analysis was used to analyze the correlation between the expression level of miR-499 and Gensini score, as well as the number of vessel branches in coronary artery disease. The evaluation value of miR-499 in assessing the severity of coronary artery disease was analyzed by using receiver operating characteristic (ROC) curve. Results ·The expression level of miR-499 increased with the severity of coronary artery disease (P=0.000). The expression level of miR-499 was positively correlated with Gensini score and cTnI (r=0.331, r=0.143, P<0.05), respectively, but not with LVEF (P>0.05), while Gensini score was not correlated with cTnI and LVEF (P>0.05). ROC analysis showed that the AUC of miR-499 for assessing the severity of coronary artery disease was 0.802 (95% CI 0.698?0.906), with sensitivity of 65.2% and specificity of 80.4%. The expression level of miR-499 increased with the increase of the number of coronary artery lesions, and was positively correlated with the number of coronary artery lesions (r=0.368, P<0.05). Conclusion ·The expression level of miR-499 in the serum of ACS patients is correlated with the severity and number of coronary artery lesions, which has a certain evaluation value in evaluating the severity of coronary artery lesions.