脑梗死患者血清miR-181d和miR-210水平表达与颈动脉狭窄程度及预后的相关性研究

Correlation between Serum miR-181d and miR-210 Levels in Patients with Cerebral Infarction and the Degree of Carotid Artery Stenosis and Prognosis

目的探讨分析脑梗死(cerebral infarction)患者血清microRNA-181d(miR-181d),microRNA-210(miR-210)水平表达与颈动脉狭窄程度及预后的相关性。方法选取2017年10月~2019年10月邢台市第三医院收治的480例脑梗死患者,根据颈部超声结果将其分为颈动脉狭窄组278例和无颈动脉狭窄组202例。检测两组患者血清miR-181d和miR-210水平,分析其水平变化与颈动脉狭窄的关系。然后随访其半年内预后情况,根据预后情况将患者分为预后良好组192例和预后不良组288例,并对影响预后不良因素进行分析比较。对影响预后不良的相关高危因素进行单因素χ^(2)检验,并筛选出可能影响的单因素,再进行多因素Logistic回归分析,根据以上因素绘制ROC曲线,评估其对预测预后不良的价值。结果颈动脉狭窄组患者血清miR-181d表达量水平显著高于无颈动脉狭窄组,而miR-210表达量水平均显著低于无颈动脉狭窄组,差异均有统计学意义(t=17.513,10.888,均P<0.05)。而颈动脉轻度狭窄患者血清miR-181d表达量显著低于中度狭窄、重度狭窄患者,而颈动脉轻度狭窄患者血清miR-210表达量显著高于中度狭窄和重度狭窄患者,差异均有统计学意义(t=5.874,6.246,2.172和5.427,均P<0.05)。随访半年内预后情况,预后良好192例,占40.00%;预后不良288例,占60.00%。两组各危险因素比较,性别、年龄、并发高血脂、并发冠心病、吸烟史、饮酒史等资料较为接近,差异无统计学意义(χ^(2)=0.237~2.475,均P>0.05)。而两组高血压、糖尿病、心房颤动、血清miR-181d和血清miR-210差异有统计学意义(χ^(2)=8.539~21.713,均P<0.05)。将有统计学意义的危险单因素纳入多因素回归分析,采用Logistic回归方程进行分析,结果显示,血清miR-181d表达量升高(OR=1.164,95%CI:1.137~1.192),血清miR-210表达量降低(OR=10.196,95%CI:6.677~15.570)是脑梗死患者预后不良的独立危险因素(OR>1,P<0.05)。并且血清miR-181d预测脑梗死患者预后不良的ROC曲线下面积为0.76(95%CI:1.013~1.124),敏感度和特异度分别为71.23%和73.45%,而血清miR-210预测脑梗死患者预后不良的ROC曲线下面积为0.79(95%CI:1.125~1.206),敏感度和特异度分别为73.42%和75.36%,联合检测的ROC曲线为0.83(95%CI:1.147~1.235),敏感度和特异度分别为79.33%和82.41%。结论血清miR-181d水平与预后不良呈正相关关系,而血清miR-210水平与预后不良呈负相关关系,血清miR-181d和miR-210是脑梗死患者预后不良的独立影响因素,检测其水平表达对于预测脑梗死患者不良事件发生具有较高价值,值得临床推广。

Objective To explore and analyze the correlation between serum miR-181d and miR-210 levels in patients with cerebral infarction and the degree of carotid artery stenosis and prognosis.Methods 480 patients with cerebral infarction admitted to the Third Hospital of Xingtai City from October 2017 to October 2019 were selected and divided into carotid artery stenosis group 278 cases and carotid artery stenosis group 202 cases based on the results of cervical ultrasound.The serum levels of miR-181d and miR-210 were detected in the two groups of patients,and the relationship between their changes and carotid artery stenosis was analyzed.Then the prognosis was followed up for half a year.According to the prognosis,the patients were divided into a good prognosis group of 192 cases and a poor prognosis group of 288 cases,and then the adverse factors affecting the prognosis were analyzed and compared.The single factorχ^(2) test analysis was performed on the related high-risk factors affecting the poor prognosis,and the single factors that may affect the prognosis were screened out,and then the multi-factor Logistic regression analysis was performed,and then the ROC curve was drawn based on the above factors to evaluate its value in predicting the poor prognosis.Results The serum levels of miR-181d and miR-210 in the carotid artery stenosis group were significantly lower than those in the carotid artery stenosis group(t=17.513,10.888,all P<0.05).The serum levels of miR-181d and miR-210 in patients with mild carotid artery stenosis were significantly higher than those in patients with moderate or severe carotid stenosis,and the difference reached statistical significance(t=5.874,6.246,2.172 and 5.427,all P<0.05).The prognosis was followed up within half a year,192 cases had a good prognosis,accounting for 40.00%,the prognosis was poor 288 cases,accounting for 60.00%.Comparing the risk factors of the two groups,the data of gender,age,combined hyperlipidemia,combined coronary heart disease,smoking history,and drinking history were relatively similar,and the difference was not statistically significant(χ^(2)=0.237~0.275,all P>0.05).There were significant differences in hypertension,diabetes,atrial fibrillation,serum miR-181d,and serum miR-210 between the two groups(χ^(2)=8.539~21.713,all P<0.05).The statistically significant single risk factors were included in the multivariate regression analysis,and the logistic regression equation was used for analysis.The results showed that serum miR-181d expression increased(OR=1.164,95%CI:1.137~71.192),serum miRDecreased expression of 210(OR=10.196,95%CI:6.677~5.570)was an independent risk factor for poor prognosis in patients with cerebral infarction(OR>1,P<0.05).The area under the ROC curve of serum miR-181d predicting poor prognosis of cerebral infarction was 0.76(95%CI:1.013~1.124),and the sensitivity and specificity at this time were 71.23%and 73.45%,respectively.The area under the ROC curve of serum miR-210 predicting poor prognosis of cerebral infarction was 0.79(95%CI:1.125~1.206),the sensitivity and specificity at this time were 73.42%and 75.36%,respectively,and the ROC curve of the combined detection was 0.83(95%CI:1.147~1.235),the sensitivity and specificity were 79.33%and 82.41%,respectively.Conclusion The serum miR-181d level was positively correlated with the poor prognosis,while the serum miR-210 level was negatively correlated with the poor prognosis.Serum miR-181d and miR-210 are independent factors influencing the poor prognosis of patients with cerebral infarction.Predicting the occurrence of adverse events in patients with cerebral infarction has good value and is worthy of clinical promotion.