高血压性脑出血患者血清miR-132、miR-34a水平及其与预后的关系

Serum levels of miR-132 and miR-34a in patients with hypertensive intracerebral hemorrhage and their relationship with prognosis

目的探讨微小RNA-132(miR-132)、miR-34a在高血压性脑出血患者血清中的表达及其与预后的关系。方法选取2020年6月—2022年6月西南医科大学附属医院、四川绵阳四〇四医院神经外科治疗高血压性脑出血患者120例为观察组。根据患者病情严重程度分为轻度亚组32例、中度亚组58例和重度亚组30例;根据患者预后分为预后良好亚组76例和预后不良亚组44例。另选取同期医院健康体检者120例为健康对照组。检测各组血清miR-132、miR-34a水平;采用多因素Logistic回归分析高血压性脑出血患者预后的影响因素;受试者工作特征曲线(ROC)分析血清miR-132、miR-34a水平对高血压性脑出血患者预后的预测价值。结果与健康对照组比较,观察组血清miR-132、miR-34a水平显著升高(t/P=11.907/<0.001、12.148/<0.001);血清miR-132、miR-34a水平比较,重度亚组>中度亚组>轻度亚组(F/P=35.229/<0.001、33.573/<0.001);与预后良好亚组比较,预后不良亚组患者糖尿病、家族遗传史比例及收缩压、血清miR-132、miR-34a显著升高[χ^(2)(t)/P=11.666/<0.001、5.083/0.024、3.557/0.001、3.208/0.002、3.592/<0.001],格拉斯哥预后评分(GOS评分)显著降低(t/P=12.458/<0.001)。Logistic回归分析结果显示,miR-132高、miR-34a高、收缩压高、有糖尿病史是高血压性脑出血患者预后的危险因素[OR(95%CI)=2.077(1.352~3.190)、3.458(1.613~7.412)、1.528(1.104~2.116)、2.778(1.448~4.657)],GOS评分高为独立保护因素[OR(95%CI)=0.682(0.501~0.928)];血清miR-132高、miR-34a高及二者联合预测高血压性脑出血患者预后的AUC分别为0.719、0.727、0.782,二者联合优于单独预测价值(Z/P=2.588/0.011、2.453/0.014)。结论高血压性脑出血患者血清miR-132、miR-34a水平显著上调,两者联合可较好地预测高血压性脑出血患者预后。

Objective To explore the expression of microRNA-132(miR-132)and miR-34a in the serum of patients with hypertensive intracerebral hemorrhage and their relationship with prognosis.Methods One hundred and twenty patients with hypertensive intracerebral hemorrhage treated by Neurosurgery Department,Affiliated Hospital of Southwest Medical University and Sichuan Mianyang 404 Hospital from June 2020 to June 2022 were selected as the observation group.According to the severity of the patient's condition,they were divided into a mild subgroup of 32 cases,a moderate subgroup of 58 cases,and a severe subgroup of 30 cases;According to the patient's prognosis,they were divided into a subgroup of 76 cases with good prognosis and a subgroup of 44 cases with poor prognosis.Another 120 healthy individuals who underwent physical examinations at the same hospital during the same period were selected as the healthy control group.Detect the levels of serum miR-132 and miR-34a in each group;Using multivariate logistic regression to analyze the influencing factors of prognosis in patients with hypertensive intracerebral hemorrhage;The predictive value of serum miR-132 and miR-34a levels in predicting the prognosis of hypertensive intracerebral hemorrhage patients by analyzing the working characteristic curve(ROC)of subjects.Results Compared with the healthy control group,the serum levels of miR-132 and miR-34a in the observation group were significantly increased(t/P=11.907/<0.001,12.148/<0.001);Comparison of serum miR-132 and miR-34a levels showed that the severe subgroup was more severe than the moderate subgroup and more mild subgroup(F/P=35.229/<0.001,33.573/<0.001);Compared with the subgroup with good prognosis,the proportion of diabetes,family genetic history,systolic blood pressure,serum miR-132,miR-34a in the subgroup with poor prognosis significantly increased[χ^(2)(t)/P=11.666/<0.001,5.083/0.024,3.557/0.001,3.208/0.002,3.592/<0.001],and the Glasgow Outcome Score(GOS score)significantly decreased,(t/P=12.458/<0.001).Logistic regression analysis showed that high miR-132,high miR-34a,high systolic blood pressure,and history of diabetes were risk factors for the prognosis of patients with hypertensive intracerebral hemorrhage[OR(95%CI)=2.077(1.352-3.190),3.458(1.613-7.412),1.528(1.104-2.116),2.778(1.448-4.657)].High GOS score was an independent protective factor[OR(95%CI)=0.682(0.501-0.928)];The AUC of high serum miR-132,high miR-34a,and their combination in predicting the prognosis of hypertensive intracerebral hemorrhage patients were 0.719,0.727,and 0.782,respectively.The combination of the two was superior to the single predictive value(Z/P=2.588/0.011,2.453/0.014).Conclusion The serum levels of miR-132 and miR-34a were significantly upregulated in patients with hypertensive intracerebral hemorrhage,and the combination of the two can better predict the prognosis.