血清miR-449a、PPAR-γ水平与ACI静脉溶栓患者预后的相关性分析

Correlation analysis of serum miR-449a,PPAR-γ levels and prognosis of patients with ACI undergoing intravenous thrombolysis

目的探究血清miR-449a、PPAR-γ水平与急性脑梗死(ACI)静脉溶栓患者预后的相关性。方法选取2016年1月至2019年6月于朝阳市第二医院神经内科收治的ACI患者149例为研究对象,根据发病3个月时mRS评分将患者分为预后不良组41例和预后良好组108例。收集两组患者血清学指标,荧光定量PCR技术检测血清miR-499a相对表达量,利用酶联免疫吸附法检测血清PPAR-γ水平。利用受试者工作特征曲线(ROC)评价血清PPAR-γ、miR-499a对ACI静脉溶栓患者预后不良的预测价值,多因素Logistic回归分析影响ACI患者静脉溶栓后预后不良的危险因素。结果预后良好组和预后不良组从发病至静脉溶栓时间、溶栓前NIHSS评分差异有统计学意义(P<0.05);与溶栓前相比,溶栓后血清miR-449a水平升高,PPAR-γ水平下降,差异有统计学意义(P<0.05);与预后良好组相比,预后不良组患者血清miR-449a水平降低,PPAR-γ水平升高,差异均有统计学意义(P<0.05);ROC结果显示,血清miR-449a、PPAR-γ诊断ACI患者静脉溶栓预后不良的曲线下面积(AUC)分别为0.829、0.773,二者联合诊断ACI患者预后不良的AUC为0.886,灵敏度为78.05%,特异度为91.67%。多因素Logistic回归分析,结果显示发病至静脉溶栓时间≧3 h、溶栓前NIHSS评分>10分、miR-449a水平≤0.930、PPAR-γ水平>38.177 pg·mL;是影响ACI静脉溶栓患者预后不良的独立危险因素。结论ACI静脉溶栓后预后不良组患者血清miR-449a水平较低、PPAR-γ水平较高,是影响ACI静脉溶栓患者预后不良的独立危险因素。

Objective To explore the correlation between serum miR-449 a and PPAR-γ levels and prognosis of patients with acute cerebral infarction(ACI) undergoing intravenous thrombolysis.Methods A total of149 patients with ACI admitted to the Department of Neurology of our hospital from January 2016 to June 2019 were selected as the research objects.According to the mRS score at 3 months after onset,the patients were divided into poor prognosis group(41 cases) and good prognosis group(108 cases).The serological indexes of the two groups were collected,the relative expression of miR-499 a in serum was detected by fluorescence quantitative PCR,the serum PPAR-γ level was detected by enzyme linked immunosorbent assay(ELISA).Receiver operating characteristic curve(ROC) was used to evaluate the predictive value of serum PPAR-γ and miR-499 a in patients with ACI undergoing intravenous thrombolysis,and multivariate logistic regression analysis was used to analyze the risk factors of poor prognosis in patients with ACI after intravenous thrombolysis.Results The time from onset to intravenous thrombolysis and NIHSS score before thrombolysis were significantly different between the good prognosis group and poor prognosis group(P <0.05);compared with those before thrombolysis,serum miR-449 a level increased and PPAR-γ level decreased after thrombolysis(P <0.05);compared with those in the good prognosis group,the serum miR-449 a level was decreased and PPAR-γ level was increased in the poor prognosis group(P <0.05);ROC results showed that the area under the curve(AUC) of serum miR-449 a and PPAR-γ in the diagnosis of poor prognosis of intravenous thrombolysis in patients with ACI was 0.829 and 0.773,respectively,the AUC of combined diagnosis of poor prognosis in patients with ACI was 0.886,the sensitivity was 78.05%,and the specificity was 91.67%.Multivariate logistic regression analysis showed that the time from onset to intravenous thrombolysis≥ 3 h,NIHSS score before thrombolysis> 10,miR-449 a level≤0.930,PPAR-γ level> 38.177 pg·mL;were independent risk factors for poor prognosis of patients with ACI undergoing intravenous thrombolysis.Conclusion The level of serum miR-449 a is lower in patients with poor prognosis after intravenous thrombolysis,and the level of PPAR-γ is higher.They are independent risk factors for poor prognosis of patients with ACI after intravenous thrombolysis.