高血压性脑出血患者血清miR-141-3p、miR-29a-3p水平变化及临床意义

Changes and clinical significance of serum miR-141-3p and miR-29a-3p expression in patients with hypertensive intracerebral hemorrhage

目的观察高血压性脑出血(HICH)患者血清miR-141-3p、miR-29a-3p水平变化,并探讨其与病情以及预后的关系。方法选择167例HICH患者(HICH组),根据斯堪纳维亚卒中量表(SSS)评分将患者分为轻型组(0~15分,42例)、中型组(16~30分,67例)和重型组(31~45分,58例),根据出院3个月后格拉斯哥预后(GOS)评分分为预后良好组(>4分,87例),预后不良组(≤4分,80例),另选择同期于我院体检的64例健康志愿者(对照组)。比较组间血清miR-141-3p、miR-29a-3p和肿瘤坏死因子-α(TNF-α)、IL-1β和IL-6水平。采用Pearson相关分析miR-141-3p、miR-29a-3p与炎性因子的相关性,多因素Logistic回归分析HICH患者预后不良的危险因素,受试者工作特征(ROC)曲线分析miR-141-3p、miR-29a-3p预测HICH患者预后不良的价值。结果HICH组血清miR-141-3p、miR-29a-3p水平低于对照组,血清TNF-α、IL-1β和IL-6水平高于对照组(P均<0.01)。重型组血清miR-141-3p、miR-29a-3p水平低于中型组和轻型组,血清TNF-α、IL-1β、IL-6水平高于中型组和轻型组(P均<0.01);中型组血清miR-141-3p、miR-29a-3p水平低于轻型组,血清TNF-α、IL-1β、IL-6水平高于轻型组(P均<0.01)。HICH组血清miR-141-3p、miR-29a-3p水平与TNF-α、IL-1β、IL-6水平均呈负相关(P均<0.01)。高水平miR-141-3p(OR=0.656,95%CI:0.500~0.862,P<0.01)、miR-29a-3p(OR=0.733,95%CI:0.581~0.926,P<0.01)是HICH预后的保护因素。miR-141-3p、miR-29a-3p预测HICH预后不良的曲线下面积为0.675、0.688,联合预测曲线下面积为0.898,高于单独指标预测(Z分别为4.950、5.325,P均<0.05)。结论HICH患者血清miR-141-3p、miR-29a-3p水平均降低,且与神经损伤程度加重以及预后不良有关。

Objective To observe the changes of miR-141-3p and miR-29a-3p expression in patients with hypertensive intracerebral hemorrhage(HICH),and to explore their relationship with their condition and prognosis.Methods Totally 167 patients with HICH(HICH group)were selected and then were divided into the mild group(0-15 points,42 cases),medium group(16-30 points,67 cases),and severe group(31-45 points,58 cases)according to the score of Scandinavian Stroke Scale(SSS).According to the Glasgow prognosis(GOS)score at 3 months after discharge,they were divided into the good prognosis group(>4 points,87 cases)and poor prognosis group(≤4 points,80 cases),and 64 healthy volunteers(control group)who underwent physical examination in our hospital at the same time were selected.The serum levels of miR-141-3p,miR-29a-3p,and serum tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),and interleukin-6(IL-6)levels were compared between groups.Pearson correlation was used to analyze the correlation between miR-141-3p,miR-29a-3p and inflammatory factors,multivariate Logistic regression was used to analyze the risk factors of poor prognosis in HICH patients,and receiver operating characteristic(ROC)curve was used to analyze the value of miR-141-3p and miR-29a-3p in predicting the poor prognosis of HICH patients.Results The expression levels of serum miR-141-3p and miR-29a-3p in the HICH group were lower than those of the control group,and the serum levels of TNF-α,IL-1βand IL-6 were higher than those of the control group(all P<0.01).The expression levels of serum miR-141-3p and miR-29a-3p in the severe group were lower than those in the medium and mild groups,and the levels of serum TNF-α,IL-1β,and IL-6 were higher than those in the medium and mild groups(all P<0.01).The expression levels of serum miR-141-3p and miR-29a-3p in the medium group were lower than those of the mild group,and the serum levels of TNF-α,IL-1β,and IL-6 were higher than those of the mild group(t values=7.042,4.576,4.338,7.968,and 4.576,all P<0.01).The expression levels of serum miR-141-3p and miR-29a-3p in the HICH group were negatively correlated with the levels of TNF-α,IL-1β,and IL-6(all P<0.01).High expression of miR-141-3p(OR=0.656,95%CI:0.500-0.862,P<0.01)and miR-29a-3p(OR=0.733,95%CI:0.581-0.926,P<0.01)were protective factors for the prognosis of HICH.The area under the curve of miR-141-3p and miR-29a-3p in predicting the poor prognosis of HICH was 0.675 and 0.688,and the area under the combined prediction curve was 0.898,which was higher than that predicted by single index(Z=4.950 and 5.325,respectively;all P<0.05).Conclusion The expression of serum miR-141-3p and miR-29a-3p of HICH patients decreased,which was related to the aggravation of nerve injury and poor prognosis.