外周血循环微小RNA-125a/b对短暂性脑缺血发作后的脑卒中风险预测价值

Predictive value of microRNA-125a/b in peripheral blood circulation for stroke risk after transient ischemic attack

目的探讨短暂性脑缺血发作后患者外周血循环微小RNA-125a/b(miR-125a/b)水平对缺血性脑卒中的风险预测价值。方法选取2019年5月至2020年6月于石家庄平安医院住院治疗的短暂性脑缺血发作患者150例,根据90 d内有无发生缺血性脑卒中,将其分为缺血性脑卒中组58例和非缺血性脑卒中组92例。采用实时荧光定量PCR法检测miR-125a/b水平,采用Essen脑卒中风险评分(ESRS)、ABCD2、ABCD3-Ⅰ、脑卒中预测工具-Ⅱ(SPI-Ⅱ)对患者行缺血性脑卒中风险预测评分,分析缺血性脑卒中患者miR-125a/b水平与各评分相关性、miR-125a/b水平对短暂性脑缺血发作后发生缺血性脑卒中的预测价值。结果缺血性脑卒中组miR-125a水平低于非缺血性脑卒中组,miR-125b水平、ESRS、ABCD2、ABCD3-Ⅰ、SPI-Ⅱ评分高于非缺血性脑卒中组(t=8.206、8.755、8.925、6.293、4.949、6.508,P<0.05)。缺血性脑卒中患者miR-125a水平与ESRS、ABCD2、ABCD3-Ⅰ、SPI-Ⅱ评分呈负相关(r=-0.511、-0.505、-0.480、-0.487,P<0.05);miR-125b水平与ESRS、ABCD2、ABCD3-Ⅰ、SPI-Ⅱ评分呈正相关(r=0.513、0.504、0.501、0.485,P<0.05)。外周血循环miR-125a/b水平预测短暂性脑缺血发作后发生缺血性脑卒中AUC分别为0.867、0.904,特异度分别为80.40%、95.70%,敏感度分别为82.80%、74.10%;二者联合预测的AUC为0.948,特异度为90.20%,敏感度为86.20%。缺血性脑卒中患者miR-125a水平随脑梗死面积增大而依次降低,miR-125b水平随脑梗死面积增大而依次上升(F=38.207、9.559,P<0.05)。miR-125b是影响短暂性脑缺血发作后发生缺血性脑卒中的危险因素(OR=2.042,P<0.05),miR-125a是影响短暂性脑缺血发作后发生缺血性脑卒中的保护因素(OR=0.513,P<0.05)。结论外周血循环miR-125a/b水平联合检测,对预测短暂性脑缺血发作后发生脑卒中可能有重要意义。

Objective To investigate the predictive value of microRNA-125a/b(miR-125a/b)level in peripheral blood circulation for ischemic stroke in patients with transient ischemic attack.Methods A total of 150 patients with transient ischemic attack who were hospitalized in Shijiazhuang Ping’an Hospital from May 2019 to June 2020 were selected.According to the occurrence of ischemic stroke within 90 days,they were divided into ischemic stroke group(58 cases)and non ischemic stroke group(92 cases).Real time fluorescence quantitative PCR(qRT-PCR)was used to detect the level of miR-125a/b.Essen stroke risk score(ESRS),ABCD2,ABCD3-Ⅰand stroke prognostic instrument-Ⅱ(SPI-Ⅱ)were used to evaluate the risk of ischemic stroke.The correlation between miR-125a/b level and each score in patients with ischemic stroke,the predictive value of miR-125a/b level for ischemic stroke after transient ischemic attack.Results The level of miR-125a in ischemic stroke group was lower than that in non ischemic stroke group,and the level of miR-125b,the scores of ESRS,ABCD2,ABCD3-Ⅰand SPI-Ⅱwere higher than those in non ischemic stroke group(t=8.206,8.755,8.925,6.293,4.949,6.508;P<0.05).The level of miR-125a was negatively correlated with ESRS,ABCD2,ABCD3-Ⅰ,SPI-Ⅱscores in patients with ischemic stroke(r=-0.511,-0.505,-0.480,-0.487;P<0.05);the level of miR-125b was positively correlated with ESRS,ABCD2,ABCD3-Ⅰ,SPI-Ⅱscores(r=0.513,0.504,0.501,0.485;P<0.05).The area under the curve(AUC)of miR-125a/b in peripheral blood circulation for predicting ischemic stroke after transient ischemic attack was 0.867 and 0.904,the specificity was 80.40%,95.70%,the sensitivity was 82.80%,74.10%,respectively;the AUC of the two combined prediction was 0.948,the specificity was 90.20%,and the sensitivity was 86.20%.In patients with ischemic stroke,the level of miR-125a decreased with the increase of cerebral infarction area,and the level of miR-125b increased with the increase of cerebral infarction area(F=38.207,9.559;P<0.05).MiR-125b was an independent risk factor for ischemic stroke after transient ischemic attack(OR=2.042,P<0.05),and miR-125a was a protective factor(OR=0.513,P<0.05).Conclusion Combined detection of miR-125a/b in peripheral blood circulation may be of great significance in predicting stroke after transient ischemic attack.