缺氧缺血性脑病新生儿血清miR-139-5p,HDAC4和GFAP表达水平及其临床价值研究

Study on the Expression Levels of Serum miR-139-5p,HDAC4 and GFAP in Neonates with Hypoxic-ischemic Encephalopathy and Their Clinical Value

目的分析血清微小核糖核酸(micro RNA,miR)-139-5p,组蛋白去乙酰化酶4(histone deacetylase 4,HDAC4)和胶质纤维酸性蛋白(glialfibrillary acidic protein,GFAP)与新生儿缺氧缺血性脑病(hypoxic-ischemic encephalopathy,HIE)脑损伤严重程度的关系。方法选取2017年1月~2022年3月广元市中心医院分娩的HIE新生儿72例为研究对象(研究组);同期健康的足月新生儿75例为对照组。实时荧光定量PCR检测血清中miR-139-5p,HDAC4表达水平。酶联免疫吸附法(ELISA)检测血清GFAP水平。Logistic回归分析影响HIE患儿重度脑损伤发生的因素。结果与对照组相比,研究组血清GFAP(1.30±0.37ng/L vs 0.50±0.15ng/L),HDAC4相对表达水平(2.05±0.39 vs 1.02±0.21)升高,miR-139-5p相对表达水平(0.63±0.14 vs 1.01±0.22)和NBNA评分(33.20±1.43分vs 39.85±2.23分)降低,差异具有统计学意义(t=17.304,20.046,12.436,21.424,均P<0.05);与轻中度组相比,重度组血清GFAP(1.61±0.47ng/L vs 1.16±0.33ng/L),HDAC4(2.43±0.37 vs 1.87±0.40)相对表达水平升高,miR-139-5p相对表达水平(0.38±0.10 vs 0.74±0.16)和NBNA评分(30.52±1.54分vs 34.46±1.38分)降低,差异具有统计学意义(t=4.690,5.669,9.900,10.884,均P<0.05)。Logistic回归分析显示,miR-139-5p低表达,HDAC4高表达,低NBNA评分,低出生后1 min内Apgar评分是影响HIE患儿重度脑损伤发生的危险因素(Waldχ^(2)=5.772~6.969,OR=1.519~1.709,均P<0.05)。Pearson分析显示,血清miR-139-5p表达水平与GFAP,HDAC4呈负相关(r=-0.416,-0.579,均P<0.05),血清HDAC4表达水平与GFAP呈正相关(r=0.437,P<0.05)。Spearman分析显示,血清mi R-139-5p表达水平与NBNA评分、出生后1 min内Apgar评分、出生后5 min内Apgar评分呈正相关(r=0.398,0.367,0.348,均P<0.05);血清HDAC4表达水平与NBNA评分、出生后1 min内Apgar评分、出生后5 min内Apgar评分呈负相关(r=-0.364,-0.345,-0.332,均P<0.05)。结论HIE患儿血清中miR-139-5p表达降低,HDAC4表达升高,mi R-139-5p,HDAC4与HIE患儿脑损伤严重程度有关。

Objective To analyze the relationship between serum micro RNA(miR)139-5p,histone deacetylase 4(HDAC4)and glial fibrillary acidic protein(GFAP)and the severity of brain injury in neonatal hypoxic-ischemic encephalopathy(HIE).Methods From January 2017 to March 2022,72 HIE neonates born in Guangyuan Central Hospital were collected as research objects(study group),while 75 healthy full-term newborns were the control group.The expression levels of miR-139-5p and HDAC4 in serum were detected by real-time fluorescence quantitative PCR.ELISA was applied to detect serum GFAP level.Binary logistic regression was applied to analyze the factors affecting the occurrence of severe brain injury in children with HIE.Results Compared with the control group,the serum GFAP(1.30±0.37ng/L vs 0.50±0.15 ng/L)and HDAC4 relative expression level(2.05±0.39 vs 1.02±0.21)in the study group were increased,the relative expression level of miR-139-5p(0.63±0.14 vs 1.01±0.22)and the NBNA score(33.20±1.43 score vs 39.85±2.23 score)was decreased,the differences were statistically significant(t=17.304,20.046,12.436,21.424,all P<0.05).Compared with the mild to moderate group,the serum GFAP level(1.61±0.47ng/L vs 1.16±0.33ng/L),HDAC4 relative expression level(2.43±0.37 vs 1.87±0.40),miR-139-5p(0.38±0.10 vs 0.74±0.16)and NBNA score(30.52±1.54 score vs 34.46±1.38 score)relative expression level in the severe group were increased,and the differences were statistically significant(t=4.690,5.669,9.900,10.884,all P<0.05).Logistic regression analysis showed that low expression of miR-139-5p,high expression of HDAC4,low NBNA score and low Apgar score within 1 min after birth were risk factors for severe brain injury in HIE children(Waldχ^(2)=5.772~6.969,OR=1.519~1.709,all P<0.05).Pearson analysis showed that the expression level of serum miR-139-5p was negatively correlated with GFAP,HDAC4(r=-0.416,-0.579,all P<0.05),while the expression level of serum HDAC4 was positively correlated with GFAP(r=0.437,P<0.05).Spearman analysis showed that the expression level of serum miR-139-5p was positively correlated with NBNA score,Apgar score within 1 min after birth,and Apgar score within 5 min after birth(r=0.398,0.367,0.348,all P<0.05).Serum HDAC4 expression level was negatively correlated with NBNA score,Apgar score within 1 min after birth,and Apgar score within 5 min after birth(r=-0.364,-0.345,-0.332,all P<0.05).Conclusion The expression of miR-139-5p in the serum of children with HIE was decreased,and the expression of HDAC4 was increased,miR-139-5p and HDAC4 were associated with the severity of brain injury in children with HIE.