血清miR-198和miR-30e-5p表达早期诊断老年急性脑梗死和预测预后的临床价值

Clinical value of serum miR-198 and miR-30e-5p expression in early diagnosis and prognosis of elderly patients with acute cerebral infarction

目的观察血清miR-198和miR-30e-5p表达早期诊断老年急性脑梗死和预测预后的临床价值。方法选择2017年1月至2018年12月在盐城市第一人民医院就诊的急性脑梗死患者137例(急性脑梗死组),同期行健康体检者70例(健康对照组)。采用定量RT-PCR的方法检测血清miR-198和miR-30e-5p表达。对急性脑梗死危险因素进行单因素和多因素分析,比较血清miR-198和miR-30e-5p表达在健康对照组、脑梗死超早期组和脑梗死急性期组的变化,及其诊断早期急性脑梗死的效能。观察血清miR-198和miR-30e-5p表达与急性脑梗死预后的关系,及其预测预后的效能。结果急性脑梗死组与健康对照组年龄、性别、饮酒史、吸烟史、高血压史、糖尿病史、甘油三酯、高密度脂蛋白胆固醇、载脂蛋白B、载脂蛋白A1和血糖水平差异均无统计学意义(P>0.05);急性脑梗死组心房颤动发生率(27.74%vs.8.57%)、收缩压(mm Hg:133.09±47.37 vs.120.78±25.61)、舒张压(mm Hg:87.12±10.34 vs.81.03±13.14)、总胆固醇(mmol/L:3.87±0.98 vs.3.58±0.69)、低密度脂蛋白胆固醇(mmol/L:2.10±0.74 vs.1.77±0.70)、纤维蛋白原(g/L:3.99±1.10 vs.3.66±1.25)、血白细胞计数(×109/L:8.18±2.41 vs.7.50±1.67)和miR-198表达水平(2-ΔΔCt:2.06±1.04 vs.1.30±0.52)明显高于健康对照组(均P<0.05),而急性脑梗死组miR-30e-5p表达水平明显低于健康对照组[(3.88±1.35)2-ΔΔCt vs.(4.82±0.87)2-ΔΔCt,P<0.05];进行二分类多元回归分析发现,舒张压、低密度脂蛋白胆固醇和miR-198表达是急性脑梗死独立危险因素(P<0.01),而miR-30e-5p表达是独立保护因素(P<0.01)。脑梗死急性期组、超早期组和健康对照组血清miR-198表达水平依次降低(2-ΔΔCt:4.90±0.96,2.76±0.62 vs.1.30±0.52,P<0.01),而miR-30e-5p表达水平依次升高(2-ΔΔCt:1.27±0.55,2.94±0.70 vs.4.82±0.87,P<0.01)。急性脑梗死治疗3个月后随访,根据改良Rankin量表将患者分为预后良好组84例,预后不良组53例。预后不良组血清miR-198表达水平明显高于预后良好组(2-ΔΔCt:4.75±1.32 vs.3.33±1.04,P<0.01),而预后不良组miR-30e-5p表达水平明显低于预后良好组(2-ΔΔCt:1.33±0.60 vs.2.52±1.00,P<0.01)。血清miR-198和miR-30e-5p表达在急性脑梗死早期诊断和预测预后方面具有较高的敏感度和特异度,两指标联合检测明显高于单个指标miR-198和miR-30e-5p表达(P<0.05)。结论miR-198和miR-30e-5p参与了急性脑梗死疾病的发生、发展,是急性脑梗死独立危险和保护因素,在急性脑梗死早期诊断和预测预后方面具有重要的临床价值。

Objective To observe the clinical value of serum miR-198 and miR-30e-5p expression in early diagnosis and prognosis of elderly patients with acute cerebral infarction.Methods 137 patients with acute cerebral infarction admitted to our hospital from January 2017 to December 2018 were enrolled in acute cerebral infarction group.Seventy healthy people in our hospital were selected as healthy control group.Serum miR-198 and miR-30e-5p expression were detected by quantitative RT-PCR.The univariate and multivariate analysis of risk factors were performed for acute cerebral infarction,the serum miR-198 and miR-30e-5p expression were observed in healthy control group,ultra-early cerebral infarction group and acute cerebral infarction group,and diagnostic efficacy of early acute cerebral infarction was also observed.The serum miR-198 and miR-30e-5p expression was compared in different prognosis of acute cerebral infarction and its prognostic efficacy was observed.Results There was no difference in age,gender,drinking history,smoking history,hypertension history,diabetes history,triglyceride,high-density lipoprotein cholesterol,apolipoprotein B,apolipoprotein A1 and blood glucose between acute cerebral infarction group and healthy control group(P>0.05),the incidence of atrial fibrillation(27.74%vs.8.57%),systolic blood pressure(mm Hg:133.09±47.37 vs.120.78±25.61),diastolic blood pressure(mm Hg:87.12±10.34 vs.81.03±13.14),total cholesterol(mmol/L:3.87±0.98 vs.3.58±0.69),low-density lipoprotein cholesterol(mmol/L:2.10±0.74 vs.1.77±0.70),fibrinogen(g/L:3.99±1.10 vs.3.66±1.25),white blood cell count(×109/L:8.18±2.41 vs.7.50±1.67)and miR-198 expression(2-ΔΔCt:2.06±1.04 vs.1.30±0.52)were significantly higher in acute cerebral infarction group than in healthy control group(P<0.05),and the miR-30e-5p expression was significantly lower in acute cerebral infarction group than in healthy control group(2-ΔΔCt:3.88±1.35,4.82±0.87,P<0.05);the multivariate regression analysis showed that diastolic blood pressure,low density lipoprotein cholesterol and miR-198 expression were independent risk factors for acute cerebral infarction(P<0.01),while miR-30e-5p expression was independent protection factors(P<0.01).The serum expression of miR-198 in acute cerebral infarction group,ultra-early cerebral infarction group and healthy control group decreased in turn(2-ΔΔCt:4.90±0.96,2.76±0.62,1.30±0.52,P<0.01),while the miR-30e-5p expression increased in turn(2-ΔΔCt:1.27±0.55,2.94±0.70,4.82±0.87,P<0.01).After 3-month treatment for acute cerebral infarction,the patients were divided into good prognosis group(84 cases)and poor prognosis group(53 cases)according to modified Rankin scale.The serum expression of miR-198 in poor prognosis group was significantly higher than that in good prognosis group(2-ΔΔCt:4.75±1.32 vs.3.33±1.04,P<0.01),while the expression of miR-30e-5p in poor prognosis group was significantly lower than that in good prognosis group(2-ΔΔCt:1.33±0.60 vs.2.52±1.00,P<0.01).Serum miR-198 and miR-30e-5p expression had high sensitivity and specificity in the early diagnosis and prognosis of acute cerebral infarction.The combined detection of two indexes was significantly higher than miR-198 or miR-30e-5p(P<0.05).Conclusion miR-198 and miR-30e-5p are involved in the development of acute cerebral infarction and are independent risk and protective factor for acute cerebral infarction.They have important clinical value in early diagnosis and prognosis of acute cerebral infarction.