急性脑梗死患者血清miRNA-126和miRNA-182表达与卒中后血管性认知功能障碍的关系

The relationship between the expression of serum miRNA-126 and miRNA-182 in patients with acute cerebral infarction and vascular cognitive impairment after stroke

目的探讨急性脑梗死(ACI)患者血清微小RNA(miRNA)-126和miRNA-182表达与卒中后血管性认知功能障碍(VCI)的关系。方法将石家庄市人民医院收治的176例ACI患者,根据治疗后3个月是否合并VCI分为非VCI组(94例)与VCI组(82例)。收集临床资料及实验室指标,检测血清miRNA-126、miRNA-182表达水平,依据治疗后3个月MMSE评分将VCI组分为轻(27例)、中(24例)、重度认知功能障碍(31例)。采用Spearman法分析血清miRNA-126、miRNA-182与MMSE评分相关性,Logistic回归分析ACI后发生VCI的影响因素,并绘制ROC曲线评估血清miRNA-126、miRNA-182表达水平对VCI的预测价值。结果VCI组年龄、Hcy高于非VCI组,文化程度低于非VCI组(P<0.05)。VCI组血清miRNA-182表达水平(1.44±0.28)高于非VCI组(1.09±0.07),miRNA-126表达水平(0.78±0.15)低于非VCI组(1.06±0.10)(P<0.05)。VCI组轻度、中度、重度认知功能障碍者血清miRNA-126水平依次降低,miRNA-182水平依次升高(P<0.05)。VCI组血清miRNA-126与MMSE评分呈正相关(r=0.770,P<0.05),miRNA-182与MMSE评分呈负相关(r=-0.734,P<0.05)。文化程度(OR=0.816)、miRNA-126(OR=0.807)、miRNA-182(OR=1.953)是ACI后发生VCI的影响因素(P<0.05)。血清miRNA-126、miRNA-182单独预测ACI后VCI的AUC分别为0.882、0.857,二者联合预测的AUC为0.951,优于单独检测miRNA-126、miRNA-182的AUC(Z=3.114、3.623,P=0.002、<0.001)。结论ACI后VCI患者血清miRNA-126表达水平降低,miRNA-182表达水平升高,均与卒中后VCI关系密切,能反映认知障碍程度,二者联合对VCI的发生具有一定的评估价值。

Objective To investigate the relationship between the expression of serum miRNA-126 and miRNA-182 in patients with acute cerebral infarction(ACI)and vascular cognitive impairment(VCI)after stroke.Methods A total of 176 ACI patients admitted to our hospital were grouped into a non VCI group(94 cases)and a VCI group(82 cases)based on whether they had VCI after 3 months of treatment.Clinical data and laboratory indicators were collected to detect the expression levels of serum miRNA-126 and miRNA-182.According to the MMSE score at 3 months after treatment,the VCI group was separated into mild(27 cases),moderate(24 cases),and severe cognitive impairment(31 cases)for testing.Spearman method was applied to analyze the correlation between serum miRNA-126,miRNA-182,and MMSE scores,Logistic regression was applied to analyze the influencing factors of VCI after ACI,receiver operating characteristic was drawn to evaluate the predictive value of serum miRNA-126 and miRNA-182 expression levels for VCI.Results The age and Hcy of the VCI group were higher than those of the non VCI group,and the educational level was lower than that of the non VCI group(P<0.05).The serum miRNA-182 expression level(1.44±0.28)in the VCI group was higher than that in the non VCI group(1.09±0.07),and the miRNA-126 expression level(0.78±0.15)was lower than that in the non VCI group(1.06±0.10)(P<0.05).The serum miRNA-126 level in patients with mild,moderate,and severe cognitive impairment in the VCI group decreased sequentially,while miRNA-182 level increased sequentially(P<0.05).The serum miRNA-126 level in the VCI group was positively correlated with MMSE score(r=0.770,P<0.05),while miRNA-182 level was negatively correlated with MMSE score(r=-0.734,P<0.05).Education level(OR=0.816),miRNA-126(OR=0.807),and miRNA-182(OR=1.953)were influencing factors for the occurrence of VCI after ACI(P<0.05).The AUC of serum miRNA-126 and miRNA-182 in predicting VCI after ACI was 0.882 and 0.857,respectively,the AUC predicted by the combination of the two was 0.951,which was better than the AUC detected separately for miRNA-126 and miRNA-182(Z/P=3.114/0.002,3.623/<0.001).Conclusion The serum miRNA-126 expression level decreases and miRNA-182 expression level increases in VCI patients after ACI,which is closely related to post-stroke VCI and can reflect the degree of cognitive impairment.The combination of the two can be used as a screening indicator for early clinical VCI.