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目的:探讨微小RNA（miR）-21、miR-29a和D-二聚体对心肌缺血再灌注的诊断价值。方法:回顾性分析浙江省乐清市人民医院2017年5月至2018年10月80例心肌缺血再灌注患者（缺血再灌注组）和80例行冠状动脉造影检查未发现冠状动脉狭窄病变患者（对照组）。缺血再灌注组患者均采用经皮冠状动脉介入疗法（PCI）治疗。缺血再灌注组于术前、术后1 d、术后5 d，对照组于入院当天，检测miR-21，miR-29a、D-二聚体、心肌肌钙蛋白（cTn）、高敏C反应蛋白（hs-CRP）和N末端脑钠肽前体（NT-proBNP）水平。结果:对照组miR-21、miR-29a、D-二聚体、cTn、hs-CRP和NT-proBNP分别为0.14 ± 0.03、0.19 ± 0.07、（123.2 ± 23.1）μg/L、（0.02 ± 0.01）μg/L、（0.65 ± 0.23）mg/L和（160 ± 78）ng/L；缺血再灌注组术前分别为0.36 ± 0.08、0.30 ± 0.05、（812.2 ± 95.7）μg/L、（0.48 ± 0.07）μg/L、（5.36 ± 2.67）mg/L和（853 ± 462）ng/L，术后1 d分别为0.31 ± 0.07、0.26 ± 0.04、（685.0 ± 29.3）μg/L、（0.41 ± 0.09）μg/L、（4.28 ± 1.59）mg/L和（560 ± 256）ng/L，术后5 d分别为0.22 ± 0.03、0.20 ± 0.04、（216.0 ± 27.6）μg/L、（0.30 ± 0.06）μg/L、（2.36 ± 0.78）mg/L和（382 ± 136）ng/L。缺血再灌注组术前及术后1、5 d miR-21、miR-29a、D-二聚体、cTn、hs-CRP和NT-proBNP水平均明显高于对照组，差异有统计学意义（n P<0.05）；在缺血再灌注组中，术后1和5 d各指标均明显低于术前，术后5 d明显低于术后1 d，差异有统计学意义（n P<0.05）。n 结论:miR-21、miR-29a、D-二聚体、cTn、hs-CRP和NT-proBNP与患者临床心肌缺血再灌注状态密切相关。“,”Objective:To investigate the diagnostic value of micro RNA (miR)-21, miR-29a and D-dimer in myocardial ischemia-reperfusion.Methods:The clinical data of 80 patients with myocardial ischemia-reperfusion (ischemia-reperfusion group) and 80 patients without coronary artery stenosis (control group) in Yueqing People′s Hospital, Zhejiang Province from May 2017 to October 2018 were retrospectively analyzed. The patients in ischemia-reperfusion group were treated with percutaneous coronary intervention (PCI). The levels of miR-21, miR-29a, D-dimer, cardiac troponin (cTN), high sensitive C-reactive protein (hs-CRP) and N-terminal pro brain natriuretic peptide (NT-proBNP) were measured in the ischemia-reperfusion group before operation, 1 and 5 d after operation, and the indexes in control group were measured on the day of admission.Results:In control group, the miR-21, miR-29a, D-dimer, cTn, hs-CRP and NT-proBNP were 0.14 ± 0.03, 0.19 ± 0.07, (123.2 ± 23.1) μg/L, (0.02 ± 0.01) μg/L, (0.65 ± 0.23) mg/L and (160 ± 78) ng/L. In ischemia-reperfusion group, the indexes before operation were 0.36 ± 0.08, 0.30 ± 0.05, (812.2 ± 95.7) μg/L, (0.48 ± 0.07) μg/L, (5.36 ± 2.67) mg/L and (853 ± 462) ng/L; the indexes 1 d after operation were 0.31 ± 0.07, 0.26 ± 0.04, (685.0 ± 29.3) μg/L, (0.41 ± 0.09) μg/L, (4.28 ± 1.59) mg/L and (560 ± 256) ng/L; the indexes 5 d after operation were 0.22 ± 0.03, 0.20 ± 0.04, (216.0 ± 27.6) μg/L, (0.30 ± 0.06) μg/L, (2.36 ± 0.78) mg/L and (382 ± 136) ng/L. The miR-21, miR-29a, D-dimer, cTn, hs-CRP and NT-proBNP before operation and 1, 5 d after operation in ischemia-reperfusion group were significantly higher than those in control group, and there were statistical differences ( n P<0.05). In ischemia-reperfusion group, the indexes 1 and 5 d after operation were significantly lower than those before operation, the indexes 5 d after operation were significantly lower than those 1 d after operation, and there were statistical differences (n P<0.05).n Conclusions:miR-21, miR-29a, D-dimer, cTn, hs-CRP and NT-proBNP are closely related to the clinical myocardial ischemia-reperfusion state.