CN111690739B - Mci诊断标志物、mci诊断试剂盒及相应的检测方法 - Google Patents
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Abstract
本发明涉及阿尔茨海默病的前驱期轻度认知功能损害(MCI)的诊断标志物,所述的标志物为血浆长链非编码核糖核酸(lncRNA),所述的血浆lncRNA包括ENST00000549762、NR_024049、T324988或ENST00000567919中的一种或多种。本研究还涉及该标志物的应用及相应的试剂盒。本发明的有益效果在于:首次发现了对MCI具有较高诊断价值的外周血lncRNA生物标志物,为采用外周血浆进行低损伤诊断MCI提供了有效标志物,有利于对阿尔茨海默病的早期诊断及早期干预。
Description
技术领域
本发明涉及阿尔茨海默病的前驱期技术领域,特别涉及诊断标志物技术领域,具体指一种轻度认知功能损害诊断标志物及其应用。
背景技术
阿尔茨海默病(Alzheimer’s disease,AD)是一种慢性神经退行性疾病,已经成为最常见的老年痴呆类型,临床表现为认知和记忆功能不断恶化,日常生活能力进行性减退,并有各种神经精神症状和行为异常,主要病理特征表现为神经细胞外淀粉样蛋白沉积形成的老年斑和神经细胞内微管相关Tau蛋白高度磷酸化而形成的神经元纤维缠结所致的大脑皮质神经元凋亡。随着人口老龄化,阿尔茨海默病的发病率逐年增加,根据世界阿尔茨海默病年度报告,每3秒钟新增一名痴呆患者,患病人数已达5000万人,预计这一数字到2050年将达到1.52亿,中国目前阿尔茨海默病已高达800多万,并且目前尚没有有效的治疗方法可以阻止或逆转这一疾病,仅可通过药物改善其症状,给医疗和护理带来了沉重的负担,例如,在美国每位中晚期AD病人的年平均医疗护理费用高达5万美元。随着我国老龄化加速,由AD所带来的医疗护理和经济负担问题会越来越严峻。因此需要进一步深入探究AD发病机制,早期诊断、早期干预疾病的发展,寻找有效的治疗方法,从而减轻医疗护理负担是老龄化社会必须解决的医疗卫生和社会经济课题。
轻度认知功能损害(mild cognitive impairment, MCI)是认知功能介于正常衰老和痴呆之间的过渡状态。MCI分为两种亚型:遗忘型MCI和非遗忘型MCI。其中遗忘型MCI越来越多地被认为是AD的前驱期。研究表明,遗忘型MCI患者每年大约有10-15%进展为可能的AD。MCI是需要干预的高危人群,也是早期预防干预的最佳切入点。近20年来,AD和MCI的诊断研究取得了长足的发展。目前AD和MCI的诊断的方法主要通过专业医生的问诊,根据病史及量表评分判断,主要是进行蒙特利尔认知评估量表、成套神经心理测验、简易精神状态量表和临床痴呆量表等,但量表的评估耗时耗力,且相对不准确。辅助检查主要包括脑结构影像学检查,可以观察到患者脑结构的宏观改变,但并不能早期发现尤其是MCI的特征性变化。老年斑成像检测作为目前AD诊断的金标准可以看到病理改变,但是代价昂贵且国内应用尚无临床应用。因此国内并无临床上可推广实际应用的临床生物标志物早期诊断方法,探索利用外周血生物学标志物筛查潜在的MCI患者将有助于AD的早期诊断与治疗。
长链非编码 RNA(long non-coding RNA, lncRNA)是一类长度大于200个核苷酸的RNA分子,通常为RNA聚合酶II转录的副产物,不能编码蛋白质,曾被认为是转录“噪音”。近来的研究发现lncRNA在人体不同组织中具有特异性且发挥着多种生物功能,尤其在神经系统的发育、神经元分化、突触的可塑性等过程中发挥重要作用,已经证明lncRNA在阿尔茨海默病患者脑中的差异表达,lncRNA的异常调节在阿尔茨海默病的发展过程中调节Aβ的产生,在突触的损伤、神经营养因子的消耗、炎症反应、线粒体损伤和神经元应激反应中发挥了重要作用,影响了阿尔茨海默病的发生发展过程。LncRNA不仅在脑组织中含量丰富,亦可稳定存在于脑脊液及血浆、血清样本中。在人体生物学生物样本中,外周血液样本最容易获取,操作简单、创伤最小、患者承担风险和痛苦最轻的样本直以。血液被认为是最适合用于筛选AD高危人群,对AD进行早期发现、诊断和治疗干预随访的生物样本。LncRNA的结构特点赋予了它免受内源性RNase酶活性的影响而被检测到并成为稳定的MCI和AD诊断血浆生物标志物的能力。申请人提供的lncRNA研究结果提示外周血数个遗传标志物lncRNA表达在MCI与正常对照之间的差异,可以将检测血浆lncRNA的表达水平作为一种筛查性早期诊断AD的常规手段,优化临床对AD的诊断策略。
发明内容
本发明的目的是克服了上述现有技术的缺点,提供了一种能够有效筛查早期诊断AD、优化临床AD诊断策略的轻度认知功能损害诊断标志物及其应用。
为了实现上述目的,本发明一方面提供了一种轻度认知功能损害(MCI)诊断标志物,具有如下构成:
所述的标志物为血浆lncRNA,所述的血浆lncRNA包括ENST00000549762、NR_024049、T324988或ENST00000567919中的一种或多种。
本发明还提供了一种所述的轻度认知功能损害诊断标志物在制备轻度认知功能损害诊断试剂盒中的应用。
本发明还提供了一种轻度认知功能损害诊断试剂盒,所述的试剂盒测定血浆中的ENST00000549762、NR_024049、T324988或ENST00000567919中的一种或多种的含量。
较佳地,所述的试剂盒中包括ENST00000549762、NR_024049、T324988或ENST00000567919中的一种或多种的引物和探针。
较佳地,所述的试剂盒中含有内参18S。
较佳地,所述的试剂盒所测定血浆中的ENST00000549762、NR_024049、T324988或ENST00000567919中的一种或多种的含量带入的计算公式为:
(1)-4.749+7972.194×ENST00000549762+5609.072×NR_024049+5.073×T324988+961.747×ENST00000567919;
(2)-4.628+8552.604×ENST00000549762+5885.819×NR_024049+6.017×T324988;
(3)-4.549+9376.777×ENST00000549762+6908.534×NR_024049+2195.991×ENST00000567919;
(4)-4.220+6823.570×NR_024049+5.849×T324988+1213.731×ENST00000567919;
(5)-4.129+6.122×T324988+1128.888×ENST00000567919+9678.308×ENST00000549762;
(6)ENST00000549762;
(7)NR_024049;
(8)T324988;或者,
(9)ENST00000567919
本发明还提供了一种基于所述的轻度认知功能损害诊断试剂盒进行MCI诊断标志物检测的方法,所述的方法包括步骤:
(1)将待检测的总RNA使用lncRNA逆转录试剂盒进行逆转录反应,得到相应的cDNA;
(2)将得到的cDNA进行实时荧光定量PCR,并以18S为内参,检测结果以∆Ct表示,其中∆Ct=Ct lncRNA - Ct 18S;
(3)将得到的∆Ct结果带入以下公式中:
-4.749+7972.194×ENST00000549762+5609.072×NR_024049+5.073×T324988+961.747×ENST00000567919,将计算值与-0.8392 比较;
-4.628+8552.604×ENST00000549762+5885.819×NR_024049+6.017×T324988,将计算值与-0.6984 比较;
-4.549+9376.777×ENST00000549762+6908.534×NR_024049+2195.991×ENST00000567919,将计算值与-0.5859比较;
-4.220+6823.570×NR_024049+5.849×T324988+1213.731×ENST00000567919,将计算值与-0.3367比较;
-4.129+6.122×T324988+1128.888×ENST00000567919+9678.308×ENST00000549762,将计算值与-0.2550比较;
ENST00000549762,将计算值与0.000160542039比较;
NR_024049,将计算值与0.000235892192比较;
T324988,将计算值与0.243255710000比较;或者,
ENST00000567919,将计算值与0.000502313314比较。
采用本发明的有益效果在于:通过严谨的实验和统计分析,首次发现了对遗忘型轻度认知功能损害具有较高诊断价值的生物标志物ENST00000549762、NR_024049、T324988、ENST00000567919的四个核酸分子。通过对lncRNA标志物和诊断试剂盒的研制和应用,突破了无便捷遗忘型轻度认知功能损害的外周血浆诊断标志物的困境,有利于对阿尔茨海默病性痴呆的早期诊断和早期干预。同时有希望极大的推进发现具有潜在治疗价值新型抗AD治疗药物靶标提供科学依据和临床支撑。
附图说明
图1为本发明的鉴定MCI患者血浆靶lncRNA组合芯片筛选、训练和验证实验设计流程图。
图2为确定本发明的诊断MCI患者血浆lncRNA组合的主要方法步骤图。
图3为应用4种lncRNA组合诊断MCI患者的ROC曲线。
图4为应用3种lncRNA组合诊断MCI患者的ROC曲线。
图5为应用1种lncRNA组合诊断MCI患者的ROC曲线。
具体实施方式
为了能够更清楚地描述本发明的技术内容,下面结合具体实施例来进行进一步的描述。
结合图1~5,对本发明提供的MCI诊断标志物的筛选、验证等进行具体说明。
一、研究对象
受试者为在上海市徐汇区社区收集的50例MCI老年病例,对照组为年龄、性别、受教育年龄数匹配的健康老人。
二、研究方法
1、芯片筛选
(1)使用TRIzol法提取RNA,并用RNasey Mini Kit(GIAGEN)纯化。使用AgilentND-1000测量纯化后的RNA浓度,电泳检测RNA完整性。
(2)抽提的RNA通过质检后,使用Arraystar RNA Flash Labeling Kit对lncRNA进行标记。标记完成后,使用Agilent SureHyb将样品与Array人类lncRNA芯片(v4.0)杂交,反应总体积为50µl。
(3)芯片经过洗涤后,使用Agilent DNA Microarray Scanner扫描。使用AgilentFeature Extraction软件采集芯片信号值。使用Agilent GeneSpring GX v12.1软件进行芯片标准化并筛选差异表达的lncRNA.
2、实时定量PCR验证
芯片筛选后,挑选于对照组比较显著上调的lncRNA进行实时定量PCR验证,具体实施方法如下:
(1)使用TRIzol法提取RNA,并用RNasey Mini Kit(GIAGEN)纯化,使用NanoDropND-1000测量纯化后的RNA浓度 。
抽提的RNA通过质检后,进行逆转录反应。反应总体积为20ul(总RNA300ng,逆转录特异引物1µl,dNTP1.6µl,加入无核酸酶的水至13.5µl,再加入RNA抑制酶0.5 µl,逆转录酶1 µl,缓冲液4 µl,0.1 M DTT1µl),在不同温度下(50℃、70℃)下进行不同时长(60分钟,15分钟)反应。
(2)实时定量PCR扩增总体系为10µl,95℃进行10分钟,再反应40个PCR循环(95℃,10秒;60℃,60秒)。以18S作为内参,检测结果是相对于参照物的量而言,以2-∆∆Ct表示的,其中2-∆∆Ct越小,表达量越低。PCR使用的引物信息如下表1.
表1:实时定量PCR使用引物信息
三、研究结果
芯片筛选阶段,MCI组中ENST00000567919、T264003、T286616、T324988、ENST00000549762、NR_024049、NR_040772 的表达水平显著低于正常对照组,具体数据如下表2所示:
表2:正常对照组(NC)及轻度认知障碍(MCI)组lncRNA表达差异水平
实时定量PCR验证阶段,MCI组中ENST00000567919、ENST00000549762、NR_024049、T324988的表达水平显著高于正常对照组,具体数据如表3所示:
表3:NC及MCI组lncRNA表达水平(2-∆∆Ct)
ROC曲线分析显示,NST00000567919、ENST00000549762、NR_024049、T324988四种lncRNA作为生物标志物对MCI具有较高的诊断价值。
以上四种lncRNA为自变量,四种lncRNA单独或联合预测为因变量进行Logistic二项回归拟合,计算得到预测概率值,将该计算模型(计算模型1、计算模型2、计算模型3、计算模型4、计算模型5、计算模型6、计算模型7、计算模型8、计算模型9)所得的数值再次进行ROC曲线分析,结果显示,计算模型所得数值依然具有较高的诊断价值。
计算模型1为:
COMPUTE 联合诊断=-4.749 + 7972.194 × ENST00000549762 + 5609.072 ×NR_024049+5.073 × T324988+961.747 × ENST00000567919,
AUC为0.941,界限值为-0.8392,敏感度为92%,特异度为84%。
计算模型2为:
COMPUTE 联合诊断123=-4.628+8552.604×ENST00000549762+5885.819× NR_024049+6.017×T324988,
AUC为0.935,界限值为-0.6984,敏感度为88%,特异度为84%。
计算模型3为:
COMPUTE 联合诊断124=-4.549+9376.777×ENST00000549762+6908.534× NR_024049+2195.991×ENST00000567919,
AUC为0.926,界限值为-0.5859,敏感度为90%,特异度为84%。
计算模型4为:
COMPUTE 联合诊断234=-4.220+6823.570×NR_024049+5.849×T324988+1213.731×ENST00000567919,
AUC为0.920,界限值为-0.3367,敏感度为88%,特异度为84%。
计算模型5为:
COMPUTE 联合诊断134=-4.129+6.122×T324988+1128.888× ENST00000567919+9678.308×ENST00000549762,
AUC为0.930,界限值为-0.2550,敏感度为90%,特异度为90%。
计算模型6为:
COMPUTE 单独诊断=ENST00000549762,
AUC为0.846,界限值为0.000160542039,敏感度为80%,特异度为80%。
计算模型7为:
COMPUTE 单独诊断=NR_024049,
AUC为0.877,界限值为0.000235892192,敏感度为82%,特异度为86%。
计算模型8为:
COMPUTE 单独诊断=T324988,
AUC为0.900,界限值为0.243255710000,敏感度为92%,特异度为82%。
计算模型9为:
COMPUTE 单独诊断=ENST00000567919,
AUC为0.856,界限值为0.000502313314,敏感度为82%,特异度为80%。
分析方法说明:使用SPSS 24.0软件饱进行数据分析,对于两组之间的比较,首先进行方差齐性检验,对于方差齐的两组数据,采用T检验进行比较分析,P值<0.05被认为具有统计学意义。将具有统计学差异的数进行二元Logistic回归,得出预测概率值,并将预测概率值用于后续ROC曲线分析。ROC曲线御用评价lncRNA在MCI诊断中的价值,曲线下面积越接近1则说明该指标的诊断价值越高。
目前MCI的生物学诊断依靠昂贵的大脑老年斑PET-CT检测和有创而难以推广的腰椎穿刺检查,无便捷微创的外周血浆检查早期诊断技术。
本发明的有益效果在于:通过广泛的文献阅读及综述,通过严谨的实验和统计分析,首次发现了对MCI具有较高诊断价值的生物标志物NST00000567919、ENST00000549762、NR_024049、T324988的四个核酸分子。通过对lncRNA标志物和诊断试剂盒的研制和应用,突破了无便捷MCI外周血浆诊断标志物的困境,有利于对阿尔茨海默病的早期诊断和早期干预。同时有希望极大的推进发现具有潜在治疗价值新型抗AD治疗药物靶标提供科学依据和临床支撑。
在此说明书中,本发明已参照其特定的实施方式作了描述。但是,很显然仍可以作出各种修改和变换而不背离本发明的精神和范围。因此,说明书和附图应被认为是说明性的而非限制性的。
Claims (7)
1.一种检测MCI诊断标志物含量的试剂在制备MCI诊断试剂盒中的应用,其特征在于,所述的标志物为血浆lncRNA,所述的血浆lncRNA包括ENST00000567919。
2.根据权利要求1所述的应用,其特征在于,所述的血浆lncRNA包括ENST00000567919和ENST00000549762。
3.根据权利要求1所述的应用,其特征在于,所述的血浆lncRNA包括ENST00000567919和NR_024049。
4.根据权利要求1所述的应用,其特征在于,所述的血浆lncRNA包括ENST00000567919、NR_024049和ENST00000549762。
5.根据权利要求1至4中任一项所述的应用,其特征在于,所述的试剂盒中包括检测MCI诊断标志物含量的引物和探针。
6.根据权利要求5所述的应用,其特征在于,所述的试剂盒中含有检测内参18S含量的试剂。
7.根据权利要求4所述的应用,其特征在于,所述的试剂盒测定血浆中标志物的含量带入的计算公式为:
-4.549+9376.777×ENST00000549762的含量+6908.534×NR_024049的含量+2195.991×ENST00000567919的含量。
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