脑梗死患者血清miR-497,TNF-α表达水平变化及其临床意义

Expressive level changes of serum miR-497 and TNF-α in patients with cerebral infarction and their clinical significances

目的探讨急性脑梗死(Acute cerebral infarction,ACI)患者血清微小RNA-497(MicroRNA-497,miR-497)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)的表达水平变化及其临床意义。方法选取2016年1月-2019年11月本院收治的96例ACI患者,称ACI组,并选取本院同期98例体检健康者,称对照组;采用实时荧光定量PCR(Real-time fluorescent quantitative PCR,qRT-PCR)法检测所有研究对象血清miR-497表达水平;采用酶联免疫吸附法(Enzyme-linked immunosorbent assay,ELISA)检测所有研究对象血清肿瘤坏死因子-α水平;评估ACI患者神经功能缺损程度、计算脑梗死体积,比较不同神经功能缺损程度/脑梗死体积的ACI患者血清miR-497、TNF-α水平;Pearson法分析ACI患者血清miR-497、TNF-α水平与神经功能缺损程度评分(National institutes of health stroke scale,NIHSS)、脑梗死体积的关系;采用受试者工作特征曲线(Receiver operating characteristic curve,ROC)评价血清miR-497、TNF-α对ACI的诊断价值。结果 ACI组血清miR-497、TNF-α水平均明显高于对照组(P<0.05);ACI患者血清miR-497、TNF-α水平随神经功能缺损程度加重、脑梗死体积增加均呈递增趋势(P均<0.05);ACI患者血清miR-497、TNF-α水平与脑梗死体积、NIHSS评分均呈正相关(r=0.423,0.514,0.542,0.399,P均<0.05);血清miR-497、TNF-α对ACI诊断的曲线下面积(Area under curve,AUC)为0.848、0.806,截断值分别为1.29、1.27,相应灵敏度分别为82.3%、81.3%,特异度分别为76.5%、77.6%;两者联合诊断ACI的AUC为0.907,其灵敏度、特异度分别为81.3%、90.8%。结论 miR-497、TNF-α在ACI患者血清中表达均上调,且与神经功能缺损程度、脑梗死体积有关,均可能在ACI进展中起一定作用,两者联合可有效提高ACI的诊断效能,有助于诊断、评估ACI患者的病情。

Objective To investigate the expressive level changes of MicroRNA-497(miR-497) and tumor necrosis factor-α(TNF-α) in the serum of patients with acute cerebral infarction(ACI) and their clinical significances.Methods A total of 96 patients with ACI admitted to our hospital from January 2016 to November 2019 were selected, called the ACI group;and 98 healthy people of physical examination in the same period of our hospital were selected, called the control group. The expressive level of miR-497 was detected by real-time fluorescent quantitative PCR(qRT-PCR), the expressive level of tumor necrosis factor-α(TNF-α) in serum of all subjects was detected by enzyme-linked immunosorbent assay(ELISA), the degree of neurological deficit in patients with ACI was evaluated, and the volume of cerebral infarction was calculated, the expressive levels of miR-497 and TNF-α in the serum of ACI patients with different neurological deficit/infarction volume were compared. Pearson’s method was used to analyze the relationships between the expressive levels of miR-497, TNF-α and national institutes of health sStroke scale(NIHSS), the volume of cerebral infarction. And the diagnostic values of serum miR-497 and TNF-α in ACI were evaluated by receiver operating characteristic curve(ROC).Results The expressive levels of serum miR-497 and TNF-α in ACI group were significantly higher than those in control group(P<0.05), the expressive levels of miR-497 and TNF-α in ACI patients increased with the severity of neurological deficit and the volume of cerebral infarction(P<0.05), the expressive levels of serum miR-497 and TNF-α were positively correlated with cerebral infarction volume and NIHSS score(r=0.423,0.514,0.542,0.399,P<0.05), the area under curve(AUC) of serum miR-497 and TNF-α in the diagnosis of ACI were 0.848 and 0.806 respectively, the cutoff value was 1.29 and 1.27 respectively, the corresponding sensitivity was 82.3% and 81.3% respectively, and the specificity was 76.5% and 77.6% respectively, the AUC of the combination in the diagnosis of ACI was 0.907, and the sensitivity and specificity were 81.3% and 90.8%, respectively.Conclusion MiR-497 and TNF-α were up-regulated in the serum of ACI patients, which were related to the degree of neurological deficit and the volume of cerebral infarction, they might play a role in the progression of ACI, and the combination of the two could effectively improve the diagnosis efficiency of ACI and help to diagnose and evaluate the condition of patients with ACI.