颅脑损伤患者miR-124水平变化及其对预后的预测价值分析

Changes of miR-124 level in patients with traumatic brain injury and its prognostic value

目的 探讨不同损伤程度颅脑损伤(TBI)患者外周血微小RNA-124(miR-124)水平变化及其对预后的预测价值。方法 选取2019年5月至2021年8月该院收治的108例TBI患者作为研究对象,其中72例作为训练组,36例作为验证组;另选取同期36例健康体检者作为对照组。检测所有TBI患者入院时、出院前1 d和对照组体检当天的外周血miR-124水平,比较训练组、对照组miR-124水平。训练组根据入院时的格拉斯哥昏迷量表评分将患者损伤程度分为轻、中、重度,根据出院后3个月时的扩展格拉斯哥结局量表评分将患者预后分为预后良好、预后不良。采用多因素Cox回归模型分析TBI患者预后的影响因素,采用受试者工作特征(ROC)曲线分析出院前1 d miR-124对TBI患者预后的预测价值,并进行组外验证。结果 训练组入院时、出院前1 d miR-124水平均高于对照组(P<0.05),训练组出院前1 d miR-124水平低于入院时(P<0.05)。入院时miR-124水平与损伤程度呈正相关(r=0.628,P<0.05)。校正合并脑疝、中线移位>5mm、瞳孔对光反应、脑血肿体积后,出院前1 d miR-124水平是预后的独立影响因素(P<0.05)。出院前1 d miR-124预测预后不良的曲线下面积为0.784(P<0.05),组外验证结果显示,以出院前1 d miR-124≤1.41为预后不良的判断标准,其预测预后不良的灵敏度为80.00%,特异度为80.76%,准确度为80.56%。结论 TBI患者外周血miR-124水平与损伤程度呈正相关,且可有效预测患者预后情况。

Objective To investigate the changesof microRNA-124(miR-124) level in peripheral blood and its prognostic value in patients with different degrees of traumatic braininjury.Methods A total of 108 TBI patients in thishospital from May 2019 to August 2021 were selected as the research subjects, including 72 cases as the training group and 36 cases as the validation group. During the same period, another 36 healthy subjects were selected as the control group.The levels of miR-124 in peripheral blood of all TBI patients at admission, 1 day before discharge and the day of physical examination of control group were detected, and the levels of miR-124 in the training group and the control group were compared.In the training group, the degree of injury was divided into mild, moderate and severe according to the Glasgow coma scale score at admission, and the prognosis was divided into good and poor according to the extended Glasgow outcome scale score at 3 months after discharge.Multivariate Cox regression model was used to analyze the prognostic influencing factors of TBI patients, and receiver operating characteristic(ROC) curve was used to analyze the predictive value of miR-124 on prognosis of TBI patients 1 day before discharge, and validation was performed outside the group.Results The level of miR-124 in the training group at admission and 1 day before discharge was higher than that in the control group(P<0.05),while the level of miR-124 in the training group at 1 day before discharge was lower than that at admission(P<0.05).The level of miR-124 was positively correlated with the degree of injury at admission(r=0.628,P<0.05).After adjustment for combined brain herniation, midline shift>5 mm, pupillary response to light, and volume of cerebral hematoma, the level of miR-124 1 day before discharge was an independent prognostic factor(P<0.05).The area under the curve of miR-124 level 1 day before discharge predicting poor prognosis was 0.784(P<0.05).The out-of-group validation results showed that the sensitivity, specificity and accuracy of predicting poor prognosis were 80.00%,80.76% and 80.56%, respectively, with miR-124≤1.41 1 day before discharge as the judgment standard of poor prognosis.Conclusion The level of miR-124 in peripheral blood of patients with TBI is positively correlated with the degree of injury, and it can effectively predict the prognosis of patients.