caveolin-1、miR-146a对急性脑梗死患者rt-PA静脉治疗后出血性转化的影响

Effects of Caveolin-1 and miR-146a on Hemorrhagic Transformation after Intravenous rt-PA Therapy in Patients with Acute Cerebral Infarction

【目的】探讨血浆小窝蛋白-1(caveolin-1)、微小RNA-146a(miR-146a)对急性脑梗死(ACI)患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗后出血性转化(HT)的影响。【方法】选择rt-PA治疗后发生HT的104例ACI患者为HT组,另选择同期接受rt-PA静脉治疗后未发生HT的536例ACI患者为非HT组。比较两组血浆caveolin-1、miR-146a水平的差异;Pearson法分析HT组血浆caveolin-1与miR-146a表达水平的相关性;采用受试者工作特征(ROC)曲线分析血浆caveolin-1、miR-146a对ACI患者rt-PA静脉溶栓治疗后HT的预测价值;采用多因素Logistic回归分析治疗后HT的影响因素。【结果】HT组血浆caveolin-1表达水平显著高于非HT组(P<0.05),miR-146a表达水平显著低于非HT组(P<0.05)。HT组血浆miR-146a与caveolin-1表达水平呈负相关(r=-0.538,P=0.000)。ROC曲线分析结果显示,血浆miR-146a、caveolin-1预测ACI患者rt-PA静脉溶栓治疗后HT的曲线下面积(AUC)分别为0.868、0.878,miR-146a联合caveolin-1预测ACI患者rt-PA静脉溶栓治疗后发生HT的AUC为0.938。多因素回归分析显示:合并房颤病史、心源性栓塞、溶栓前NIHSS评分高、发病至溶栓时间长、溶栓前血糖水平高、溶栓后2 h收缩压高以及血浆caveolin-1表达水平高、miR-146a表达水平低是ACI患者rt-PA静脉溶栓治疗后HT的影响因素(P<0.05)。【结论】血浆caveolin-1、miR-146a异常表达与ACI患者rt-PA静脉溶栓治疗后HT的发生密切相关,二者联合检测能够用于预测HT的发生。

【Objective】To investigate the effects of plasma caveolin-1(caveolin-1)and microRNA-146a(miR-146a)on hemorrhagic transformation(HT)after intravenous thrombolytic therapy with recombinant tissue type plasminogen activator(rt-PA)in patients with acute cerebral infarction(ACI).【Methods】A total of 104 ACI patients who developed HT after intravenous treatment with rt-PA were selected as the HT group,while 536 ACI patients who did not develop HT after intravenous treatment with rt-PA during the same period were selected as the non-HT group.The differences in plasma levels of caveolin-1 and miR-146a between the two groups were analyzed.Pearson method was used to analyze the correlation between the expression levels of plasma caveolin-1 and miR-146a in HT group.Receiver operating characteristic(ROC)curve analysis was applied to analyze the predictive value of plasma caveolin-1 and miR-146a on HT after rt-PA intravenous thrombolysis in ACI patients.The independent influencing factors of HT were analyzed by multivariate logistic regression.【Results】The expression level of plasma caveolin-1 in the HT group was significantly higher than that in the non-HT group(P<0.05);And the expression level of miR-146a was significantly lower than that in the non-HT group(P<0.05).The miR-146a and caveolin-1 expression levels were negatively correlated in HT group(r=-0.538,P=0.000).The ROC results showed that the areas under the curve of plasma miR-146a and caveolin-1 in predicting HT after rt-PA intravenous thrombolysis in ACI patients were 0.868 and 0.878,respectively,and the areas under the curve predicted by miR-146a combined with caveolin-1 was 0.938.Multivariate regression analysis showed that the history of atrial fibrillation,cardioembolism,high NIHSS score before thrombolysis,long time from onset to thrombolysis,high blood glucose level before thrombolysis,high systolic blood pressure 2 hours after thrombolysis and high plasma caveolin-1 expression level and high expression level of miR-146a were the influencing factors of HT after rt-PA intravenous thrombolysis in ACI patients(P<0.05).【Conclusion】The abnormal expression of plasma caveolin-1 and miR-146a is closely related to the occurrence of HT after intravenous thrombolysis with rt-PA in ACI patients,and the combined detection of the two can be used to predict the occurrence of HT.