进展型脑梗死患者miRNA的表达水平及临床意义

Expression of microRNAs in patients with progressive cerebral infarction and its clinical significance

目的探讨进展型脑梗死患者微小RNA(miRNA)的表达水平及临床意义。方法回顾性分析2016年7月至2018年7月期间我院收治的138例脑梗死患者病例资料。根据斯堪的那维亚卒中量表(SSS)将其分为对照组(稳定型脑梗死,82例)和观察组(进展型脑梗死,56例)。观察组患者按照高级中枢损伤严重程度评定标准(MESSS)评分为轻度进展(30例)、中度进展(17例)、重度进展(9例)三个亚组。对观察组出院两个月后进行预后随访,并将其分为预后不良组及预后良好组。分析进展型脑梗死患者miRNA的表达水平及临床意义。结果进展型脑梗死患者的miRNA-21、miRNA-223水平均显著高于稳定型脑梗死患者(P <0. 05);miRNA-21、miRNA-223的高表达均是进展型脑梗死的危险因素(P <0. 05),且进展型脑梗死的严重程度与血清miRNA-21、miRNA-223的表达水平均呈正相关(r=0. 834,P=0. 008;r=0. 896,P=0. 001)。预后不良组患者血清miRNA-21、miRNA-223表达水平显著高于预后良好组(P <0. 05);血清miRNA-21、miRNA-223表达水平预测进展型脑梗死预后的AUC面积分别为0. 805、0. 834,并分别得出截断值4. 45 (敏感度77. 14%,特异性82. 28%)、7. 06(敏感度82. 86%,特异性73. 42%)。结论进展型脑梗死患者miRNA-21、miRNA-223呈高表达,且其表达水平与脑梗死严重程度呈正相关,同时对预测进展型脑梗死预后均具有较高的敏感度和特异度,有可能成为一种早期诊断和预测进展型脑梗死生物标志物。

Objective To investigate the expression of microRNAs(miRNAs)in patients with progressive cerebral infarction and its clinical significance.Methods A retrospective analysis was performed on the clinical data of 138 patients with cerebral infarction admitted to our hospital from July 2016 to July 2018.According to the Scandinavian Stroke Scale,the patients were divided into control group(stable cerebral infarction,n=82)and observation group(progressive cerebral infarction,n=56).Patients in the observation group were further divided into three subgroups,i.e.,mild progression(n=30),moderate progression(n=17),and severe progression(n=9),according to the score of modified Edinburgh-Scandinavian stroke scale.They were followed up for prognosis two months after discharge and divided into poor prognosis group and good prognosis group.An analysis was performed on the expression of miRNAs in patients with progressive cerebral infarction and its clinical significance.Results Patients with progressive cerebral infarction had significantly higher levels of miRNA-21 and miRNA-223 than those with stable cerebral infarction(P<0.05).The high expression of miRNA-21 and miRNA-223 was a risk factor for progressive cerebral infarction(P<0.05).The severity of progressive cerebral infarction was positively correlated with serum levels of miRNA-21 and miRNA-223(r=0.834,P=0.008;r=0.896,P=0.001).Patients with poor prognosis had significantly higher expression levels of serum miRNA-21 and miRNA-223 than those with good prognosis(P<0.05);the areas under the receiver operating characteristic curves of serum miRNA-21 and miRNA-223 expression levels in predicting the prognosis of progressive cerebral infarction were 0. 805 and 0. 834,respectively;the cut-off values were 4. 45 ( sensitivity= 77. 14%,specificity = 82. 28%) and 7. 06 ( sensitivity = 82. 86%,specificity = 73. 42%) ,respectively. Conclusions Both miRNA-21 and miRNA-223 are highly expressed in patients with progressive cerebral infarction,and their expression levels are positivelycorrelated with the severity of cerebral infarction. In addition,they have high sensitivity and specificity in predicting the prognosis ofprogressive cerebral infarction,which can be used as biomarkers for early diagnosis and prediction of progressive cerebral infarction.