外泌体miRNAs联合模型预测脑挫裂伤患者预后的临床意义

Clinical Significance of Exosome miRNAs Combined Model in Predicting Prognosis of Patients with Brain Contusion and Laceration

目的:探究外泌体miRNAs联合模型预测脑挫裂伤患者预后的临床意义。方法:选取我院2020年1月-2022年3月收治的脑挫裂伤患者200例,分别检测入院时和1周后患者血清外泌体miR-21、miR-124、miR-335的表达水平。根据伤后3个月的COS评分分为预后良好组(COS4~5分)与预后不良组(COS1~3分)。采用Logistic回归模型分析外泌体miRNAs与脑挫裂伤患者预后不良的相关性,再绘制受试者工作特征(ROC)曲线计算该联合模型预测的敏感度和特异度,评估外泌体miRNAs联合模型在脑挫裂伤患者诊疗中的临床意义。结果:2组患者入院时GCS评分、出血量、中线移位、脑挫裂伤体积、miR-21、miR-124、miR-335对比差异具有统计学意义(P<0.05);2组合并颅骨骨折例数、是否应用抗凝药物对比差异无统计学意义(P>0.05);Cox回归分析,出血量>12mL、中线移位>5mm、脑挫裂伤体积>20cm^(2)、miR-21>2.5、miR-124>3、miR-335>2.5是预后良好的独立影响因素,入院时CCS评分>8分是预后良好的保护因素。结论:外泌体miRNAs对于预后具有重要意义,对于指导临床治疗具有重要作用。

Objective:To explore the clinical significance of exosome miRNAs combined model in predicting the prognosis of patients with brain contusion and laceration.Methods:A total of 80 patients with brain contusion and laceration admitted to Poyang County Peo-ples Hospital of Jiangxi Province from January 2020 to March 2022 were selected,and the expression levels of serum exosome Mir-21,Mir-124 and Mir-335 were detected on admission and 1w later,respectively.According to the COS score of 3 months after injury,the patients were divided into good prognosis group(COS 4~5)and poor prognosis group(COS 1~3).Multivariate Cox regression model was used to analyze the correlation between exosome miRNAs and poor prognosis in patients with brain contusion and lactation.LASSO method was used to construct the prediction model combined with relevant factors,and then receiver operating characteristic(ROC)curve was drawn to calculate the sensitivity and specificity of the combined model.To evaluate the clinical significance of exosome miR-NAs combined model in the diagnosis and treatment of brain contusion and laceration.Results:There were statistically significant differ-ences in GCS score,blood loss,midline displacement,brain contusion volume,Mir-21,Mir-124 and Mir-335 between the two groups at admission(P<0.05),while there were no statistically significant dfferences in the number of cases with skullfracture and whether anticoagulant drugs were applied between the two groups(P>0.05).Cox regression analysis showed that blood loss>12mL,midline displacement>5mm,brain contusion volume>20cm2,mir-21>2,mir-124>2,mir-335>2 were independent in-fluencing factors for good prognosis,and CCS score>8 on admission was protective factor for good prognosis.Conclusion:Exosome miRNAs play an important role in prognosis and clinical treatment.