血清miR-92a和miR-155-5p表达对老年高血压合并脑梗死诊断与预后的影响

Effects of expressions of miR-92a and miR-155-5p on the diagnosis and prognosis of elderly patients with hypertension complicated by cerebral infarction

目的观察血清miR-92a和miR-155-5p表达对老年高血压合并脑梗死诊断和预后的影响。方法选择2017年1月至2018年12月诊断为高血压合并急性脑梗死患者105例为高血压合并脑梗死组;选择同期诊断为原发性高血压患者89例和健康体检者45例,为高血压组和健康对照组。采用定量RT-PCR方法测定3组血清miR-92a和miR-155-5p表达。观察高血压合并脑梗死组、高血压组和健康对照组血清miR-92a和miR-155-5p表达变化,对高血压合并脑梗死影响预后因素进行单因素和多因素分析,观察血清miR-92a和miR-155-5p表达在高血压合并脑梗死诊断和预测预后的灵敏度和特异性。结果高血压合并脑梗死组患者血清miR-92a表达水平明显高于高血压组和健康对照组(P<0.01),而高血压组明显高于健康对照组(P<0.01);miR-155-5p表达水平明显低于高血压组和健康对照组(P<0.01),而高血压组低于健康对照组(P<0.01)。高血压合并脑梗死患者随访3个月后,41例患者评分为预后不良,64例患者为预后良好。单因素分析发现,性别、年龄、吸烟史、饮酒史、糖尿病史、冠心病史、心房颤动史、HDL-C、LDL-C、三酰甘油、总胆固醇、空腹血糖、血肌酐、NIHSS评分和梗死部位与高血压合并脑梗死预后差异无统计学意义(P>0.05),而收缩压、舒张压、D-二聚体、病灶直径、miR-92a和miR-155-5p与高血压合并脑梗死患者的预后呈密切相关(P<0.05)。多因素分析发现收缩压、病灶直径、miR-92a和miR-155-5p是高血压合并脑梗死预后的独立预后因素(P<0.05)。血清miR-92a和miR-155-5p表达在高血压合并脑梗死的诊断和预测预后具有较高诊断效能,联合检测曲线下面积明显高于单独miR-92a和miR-155-5p的检测(P<0.05)。结论在高血压合并脑梗死患者中,血清miR-92a表达出现明显升高,而miR-155-5p表达出现明显降低,是高血压合并脑梗死独立预后因素,联合检测在高血压合并脑梗死的诊断和预测预后方面具有较高的效能。

Objective To investigate the effects of expressions of miR-92a and miR-155-5p on the diagnosis and prognosis of elderly patients with hypertension complicated by cerebral infarction.Methods A total of elderly patients with hypertension complicated by acute cerebral infarction who were diagnosed in our hospital from January 2017 to December 2018 were enrolled as observation group,at the same time,the other 89 patients with primary hypertension were enrolled as hypertension group,moreover,the 45 subjects who underwent health examination were enrolled as control group.The serum levels of miR-92a and miR-155-5p were detected by quantitative RT-PCR,which were compared among the three groups.In addition the influencing factors on hypertension complicated by cerebral infarction were analyzed by single factor and multi-factor analysis,and the sensitivity and specificity of miR-92a and miR-155-5p expression in diagnosis and prognosis evaluation were observed.Results The serum levels of miR-92a in observation group were significantly higher than those in hypertension group and control group(P<0.01),moreover,which in hypertension group were significantly higher than those in control group(P<0.01).However the serum levels of miR-155-5p in observation group were significantly lower than those in hypertension group and control group(P<0.01),which in hypertension group were significantly lower than those in control group(P<0.01).After 3-month follow up,41 patients had a poor prognosis and 64 patients had a good prognosis in observation group.The univariate analysis showed that patient’s gender and age,smoking history,drinking history,history of diabetes,history of coronary heart disease,history of atrial fibrillation,HDL-C,LDL-C,triglycerides,total cholesterol,fasting blood glucose,serum creatinine,NIHSS scores and infarction site were not related to the prognosis of patients with hypertension complicated by cerebral infarction(P>0.05),however,thesystolic blood pressure,diastolic blood pressure,D-dimer,lesion diameter,lesion diameter miR-92a and miR-155-5p were closely related to the prognosis of patients(P<0.05).Multivariate analysis showed that the systolic blood pressure,lesion diameter,miR-92a and miR-155-5p were independent prognostic factors for patients with hypertension complicated by cerebral infarction(P<0.05).Furthermore,the detection of serum levels of miR-92a and miR-155-5p had higher efficacy of diagnosis and prognosis evaluation for patients with hypertension complicated by cerebral infarction.The area under the curve by combined detection was significantly higher than that by the detection of miR-92a or miR-155-5p only(P<0.05).Conclusion The expression levels of miR-92a in patients with hypertension complicated by cerebral infarction are significantly increased,however,those of miR-155-5p are significantly decreased,which are independent prognostic factors for hypertension complicated by cerebral infarction.Combined detection of both factiors is of higher efficacy of diagnosis and prognosis evaluation for patients with hypertension complicated by cerebral infarction.