振幅整合脑电图联合微小RNA-422a监测对急性脑梗死亚低温治疗的预后评估

Role of aEEG combined with miR-422a in assessing the outcome of ACI after low temperature therapy

目的研究振幅整合脑电图(aEEG)、α波变异百分率(PAV)联合血浆外泌体源性微小RNA(miR)-422a监测对急性脑梗死亚低温治疗的预后评估作用。方法选取我院收治的248例急性脑梗死患者作为研究对象,分为预后良好组(188例)和预后不良组(60例),分析治疗前及治疗后7 d的美国国立卫生研究院卒中量表(NIHSS)评分及格拉斯哥昏迷评分(GCS)之间的差异,采用ROC曲线对aEEG、PAV联合血浆外泌体源性miR-422a诊断的价值进行分析。结果治疗后第1、3、7天,预后良好组aEEG诊断Ⅰ型患者显著高于预后不良组,Ⅱ型及Ⅲ型患者显著低于预后不良组(P<0.05,P<0.01);预后良好组患者的病变侧及非病变侧脑电图α波诊断显著低于预后不良组(P<0.05,P<0.01)。与治疗前比较2组血浆外泌体源性miR-422a表达显著升高(P<0.05),预后良好组血浆外泌体源性miR-422a表达显著高于预后不良组(P<0.01);治疗后预后良好组NIHSS评分显著低于预后不良组(P<0.01),GCS显著高于预后不良组(P<0.01)。相关性分析显示,miR-422a、aEEGⅠ型百分率与NIHSS评分呈负相关(r=-0.336,P=0.000;r=-0.635,P=0.000),与GCS呈正相关(r=0.442,P=0.000;r=0.552,P=0.000),PAV与NIHSS评分呈正相关(r=0.584,P=0.000),与GCS呈负相关(r=-0.854,P=0.000);ROC曲线分析显示,联合检测的敏感性显著高于miR-422a、PAV、aEEGⅠ型百分率单项检测,miR-422a、PAV、aEEGⅠ型百分率的临界值分别为3.88%、22.74%及41.65%。结论aEEG、PAV联合血浆外泌体源性miR-422a监测对急性脑梗死亚低温治疗预后的评价具有重要意义,可作为日后治疗提供依据。

Objective To study the role of amplitude-integrated electroencephalo-graphy(aEEG)andαvariation combined with plasma exocrine body-derived miR-422a monitoring in assessing the outcome of acute cerebral infarction(ACI)after low temperature therapy.Methods Two hundred and forty-eight ACI patients admitted to our hospital were divided into good outcome group(n=188)and poor outcome group(n=60).Their NIHSS score and Glasgow coma scale(GCS)score before and 7 days after treatment were analyzed.The value of aEEG andαvariation combined with miR-422a in diagnosis of ACI was analyzed by ROC curve analysis.Results The diagnostic rate of aEEG in typeⅠACI patients was significantly higher and that of aEEG in types Ⅱ and Ⅲ ACI patients was significantly lower in good outcome group than in poor outcome group on days 1,3,7 after treatment(P<0.05,P<0.01).The diagnostic rate of EEGαwave in ACI side and ACI-free side was significantly lower in good outcome group than in poor outcome group(P<0.05,P<0.01).The expression level of miR-422a was significantly higher in two groups after treatment than before treatment(P<0.05)and in good outcome group than in poor outcome group(P<0.01).The NIHSS score was significantly lower while the GCS score was significantly higher in good outcome group than in poor outcome group(P=0.000).Correlation analysis showed that the percentage of miR-422a and aEEG was negatively related with the NIHSS score(r=-0.336,P=0.000;r=-0.635,P=0.000)and positively related with the GCS score in diagnosis of type Ⅰ ACI patients(r=0.442,P=0.000;r=0.552,P=0.000).The percentage ofαvariation was positively related with the NIHSS score(r=0.584,P=0.000)and negatively related with the GCS score in diagnosis of type Ⅰ ACI patients(r=-0.854,P=0.000).ROC curve analysis showed that the sensitivity of miR-422a combined with aEEG was significantly higher than that of miR-422a,αvariation and aEEG in diagnosis of typeⅠACI patients.The cut-off value of miR-422a,αvariation and aEEG was 3.88%,22.74% and 41.65%respectively in diagnosis of type Ⅰ ACI patients.Conclusion aEEG and perentage ofαvariation combined with miR-422a monitoring play an important role in assessing the outcome of ACI after low temperature therapy and can provide evidence for its future treatment.