急性缺血性脑卒中患者血清微小RNA-590水平变化及意义

Changes and significance of serum microRNA-590 level in patients with acute ischemic stroke

[目的]探究急性缺血性脑卒中(AIS)患者血清微小RNA-590(miR-590)水平变化及与预后的关系。[方法]选取2019年2月—2020年10月接受静脉溶栓和动脉取栓治疗的176例AIS患者作为研究对象,根据治疗后90天的改良Rankin量表(mRS)评分将其分为预后良好组(n=123;mRS评分0~2分)、预后不良组(n=53;mRS评分3~6分)。用实时荧光定量PCR法检测AIS患者血清miR-590水平;用受试者工作特征(ROC)曲线评价miR-590预判AIS预后的价值;用Logistic回归分析AIS预后的风险因素。[结果]预后不良组的年龄、男性占比、糖尿病史占比、空腹血糖(FPG)、总胆固醇(TC)、美国国立卫生研究院卒中量表(NIHSS)评分和入院至溶栓时间(DNT)均高于预后良好组(P<0.05)。按1∶1进行倾向性评分匹配后,治疗前预后不良组的miR-590相对水平低于预后良好组,预后不良组和预后良好组的治疗后miR-590相对水平均高于治疗前,治疗后预后不良组的miR-590相对水平升高程度高于预后良好组,差异均有统计学意义(P<0.05)。治疗前miR-590预判AIS预后的ROC曲线下面积为0.793,高于miR-590差值(治疗前和治疗后血清miR-590相对水平的差值)(P<0.001)。Logistic回归分析结果显示FPG、TC、NIHSS评分和DNT是AIS预后的独立危险因素(P<0.05),治疗前血清miR-590水平是AIS预后的独立保护因素(P<0.001)。[结论]AIS患者静脉溶栓和动脉取栓治疗前血清miR-590水平低与AIS预后不良有关。

Aim To explore the changes of serum microRNA-590(miR-590)level and its relationship with prognosis in patients with acute ischemic stroke(AIS).Methods 176 patients with AIS who received intravenous thrombolysis and arterial thrombectomy from February 2019 to October 2020 were selected as the research objects.According to the modified Rankin scale(mRS)score 90 days after treatment,the patients were divided into good prognosis group(n=123;mRS score 0~2 points)and poor prognosis group(n=53;mRS score 3~6 points).The level of serum miR-590 in patients with AIS was detected by real-time fluorescence quantitative PCR,the value of miR-590 in predicting the prognosis of AIS was evaluated by receiver operating characteristic(ROC)curve,and the risk factors of AIS prognosis were analyzed by Logistic regression.Results The age,male ratio,diabetes history,fasting plasma glucose(FPG),total cholesterol(TC),National Institute of Health Stroke Scale(NIHSS)score and door to needle time(DNT)in the poor prognosis group were higher than those in the good prognosis group(P<0.05).After propensity score matching according to 1∶1,the relative level of miR-590 in the poor prognosis group was lower than that in the good prognosis group before treatment,the relative levels of miR-590 in the poor prognosis group and the good prognosis group after treatment were higher than those before treatment,after treatment the relative level increase degree of miR-590 in the poor prognosis group was higher than that in the good prognosis group,and the differences were statistically significant(P<0.05).The area under the ROC curve of miR-590 predicting the prognosis of AIS before treatment was 0.793,which was higher than the difference of miR-590(the difference between the relative levels of serum miR-590 before and after treatment)(P<0.001).Logistic regression analysis showed that FPG,TC,NIHSS score and DNT were independent risk factors for the prognosis of AIS(P<0.05),and the level of serum miR-590 before treatment was an independent protective factor for the prognosis of AIS(P<0.001).Conclusion The low level of serum miR-590 before intravenous thrombolysis and arterial thrombectomy is related to poor prognosis in patients with AIS.