血清miR-181c联合神经损伤标志物对脑出血改良大骨瓣减压术后疗效及认知功能的预测价值

The study of serum miR-181c combined with nerve injury markers to predict the efficacy and cognitive function of modified large craniectomy for cerebral hemorrhage

目的探讨血清miR-181c联合神经损伤标志物水平对脑出血改良大骨瓣减压术后疗效及认知功能的预测价值。方法回顾性分析2016年1月-2019年6月邢台市第三医院收治的568例脑出血接受改良大骨瓣减压术治疗患者的临床资料,根据脑出血患者术后疗效分为无效组52例和有效组516例,比较各组研究对象血清miR-181c、神经损伤标志物[血清铁蛋白(SF)、胶质纤维酸性蛋白(GFAP)]表达水平。运用简易精神状态检查量表(MMSE)评估患者术后认知功能,并分析其与血清miR-181c、SF以及GFAP水平的相关性。采用受试者工作特征曲线(ROC)分析三者水平对术后认知功能的诊断价值。结果术后血肿量、美国国立卫生研究院卒中量表(NIHSS)评分以及血清miR-181c、SF、GFAP水平呈降低趋势,其中有效组各指标显著低于无效组(P<0.001)。术后1个月,185例(32.57%)患者出现认知功能障碍,平均MMSE评分为(21.35±2.10)分,Pearson相关性结果显示miR-181c、SF、GFAP表达水平均与MMSE评分呈负相关性(r=-0.641,-0.498,-0.536;P<0.05)。miR-181c以1.23为诊断截断值时,ROC曲线下面积(AUC)为0.814(95%CI:0.764~0.865);血清SF以325.36为诊断截断值时,AUC为0.681(95%CI:0.616~0.747);血清GFAP以10.25为诊断截断值时,AUC为0.634(95%CI:0.567~0.701);三者联合检测的AUC为0.886(95%CI:0.761~0.932),显著高于各单项检测(P<0.05)。结论脑出血后认知功能受损患者血清miR-181c、SF以及GFAP水平显著升高,其表达水平与病情转归密切相关,可作为疗效评估的重要指标;且三者联合检查可提高脑出血改良大骨瓣减压术后认知功能诊断效能。

Objective To investigate the predictive value of serum miR-181c combined with nerve injury markers on the efficacy and cognitive function of modified large craniectomy for cerebral hemorrhage.Methods 568 patients with cerebral hemorrhage who were treated in Xingtai Third Hospital from January 2016 to June 2019 who underwent modified large craniectomy were enrolled.According to the postoperative curative effect of cerebral hemorrhage patients,they were divided into invalid group and effective group.In 516 cases,the expression levels of serum miR-181c and nerve injury markers[serum ferritin(SF)and glial fibrillary acidic protein(GFAP)]in each group were compared.The postoperative cognitive function was evaluated by mini mental state examination scale(MMSE),and its correlation with the levels of serum miR-181c,SF and GFAP was analyzed.In addition,receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of the three levels on postoperative cognitive function.Result The volume of postoperative hematoma,NIHSS score and the levels of serum miR-181c,SF and GFAP decreased,and the indexes in the effective group were significantly lower than those in the ineffective group(P<0.001).One month after operation,185 patients(32.57%)had cognitive impairment,and the average MMSE score was(21.35±2.10).Pearson correlation results showed that the expression levels of miR-181c,SF and GFAP were negatively correlated with MMSE score(r=-0.641,-0.498,-0.536;P<0.05).When the cutoff value of serum miR-181c was 1.23,the area under the ROC curve was 0.814(95%CI:0.764-0.865).When the cutoff value of serum SF was 325.36,the area under the ROC curve was 0.681(95%CI:0.616-0.747).When the cutoff value of serum GFAP was 10.25,the area under the ROC curve was 0.634(95%CI:0.567-0.701).The area under ROC curve detected by the three combined tests was 0.886(95%CI:0.761-0.932),which was significantly higher than that detected by each single test(P<0.05).Conclusion The levels of serum miR-181c,SF and GFAP in patients with cognitive impairment after intracerebral hemorrhage are significantly increased,and their expression levels are closely related to the prognosis of the disease,which can be used as an important index for the evaluation of curative effect.The combined examination of the three can improve the diagnostic efficacy of cognitive function after modified large bone flap decompression for intracerebral hemorrhage.