谷履冰.血浆miR-181a-5p可评估急性脑梗死的病情及预后[J].内科急危重症杂志,2023,29(3):218-221
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| DOI：10.11768/nkjwzzzz20230310 |
| 中文关键词: 血浆 miR-181a-5p 急性脑梗死 凋亡 预后 |
| 英文关键词: |
| 基金项目:重庆市科技计划项目（No：2018HBRC015） |
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| 中文摘要: |
| 摘要 目的：探讨急性脑梗死（ACI）患者血浆中微小RNA(miR)-181a-5p的表达水平及临床价值。方法：收集148例ACI患者（ACI组）的临床资料，根据美国国立卫生研究院卒中量表（NIHSS）评分将其分为：轻度72例、中度35例、重度41例。ACI患者发病4.5h内用阿替普酶静脉溶栓治疗。根据出院后第90天的预后情况，将患者分为预后良好组（102例）和预后不良组（46例）。另选取同期健康体检者100例为对照组。用逆转录-聚合酶链反应（RT-PCR）检测血浆miR-181a-5p表达水平；酶联免疫吸附试验（ELISA）检测血浆中凋亡分子B淋巴细胞瘤-2基因（Bcl-2）和含半胱氨酸的天冬氨酸蛋白水解酶（caspase-1）表达水平。相关性检验用Pearson分析；用Logistic多因素回归分析影响预后的因素；绘制受试者工作特征（ROC）曲线，分析血浆miR-181a-5p预测预后的价值，计算曲线下面积（AUC）、灵敏度及特异性。结果：与对照组比较，ACI组血浆miR-181a-5p和caspase-1表达水平较高，而Bcl-2表达水平较低（P均＜0.05）。miR-181a-5p与caspase-1呈正相关（r=0.176，P=0.032），与Bcl-2呈负相关（r=-0.209，P=0.011）。轻度、中度和重度ACI患者血浆miR-181a-5p表达水平分别为（1.35±0.32）、（1.79±0.20）、（2.34±0.59），经单因素方差分析，组间比较差异有统计学意义（F=32.001，P＜0.001），病情越重，血浆miR-181a-5p表达水平越高。与预后良好组比较，预后不良组年龄更大，入院时NIHSS评分、血浆miR-181a-5p和caspase-1水平较高，而Bcl-2水平较低（P均＜0.05）。多因素分析显示，年龄、入院时NIHSS评分及血浆miR-181a-5p水平是ACI患者预后不良的独立影响因素（OR=1.532、1.832、3.111，P均＜0.05）。血浆miR-181a-5p预测不良预后的AUC为0.856（95%CI：0.815~0.886，P＜0.01），灵敏度为89.56%，特异性为70.12%。结论：ACI患者血浆中miR-181a-5p表达水平明显升高，对ACI病情和预后的早期评估有一定价值。 |
| 英文摘要: |
| Abstract Objective: To investigate the expression level and clinical value of miR-181a-5p in plasma of patients with acute cerebral infarction (ACI). Methods: The clinical data of 148 patients with ACI (ACI group) were collected. According to the National Institutes of Health Stroke Scale (NIHSS), there were 72 mild patients, 35 moderate patients, and 41 severe patients. Patients with ACI were treated with intravenous alteplase within 4.5h of onset. According to the prognosis on the 90th day after discharge, patients were divided into a good prognosis group (102 cases) and a poor prognosis group (46 cases). In addition, 100 normal people who underwent physical examination were selected as the control group. Plasma miR-181a-5p expression level was detected by reverse transcription-polymerase chain reaction (RT-PCR). The enzyme linked immunosorbent assay (ELISA) was used to detect the apoptosis molecule B-lymphoma-2 gene (Bcl-2) and cysteinyl aspartate specific proteinase 1 (caspase-1) in plasma. Pearson analysis was used for correlation test, Logistic multivariate analysis of prognostic factors. The receiver operating characteristic (ROC) curve was drawn to analyze the value of miR-181a-5p in predicting prognosis, and the area under the curve (AUC), sensitivity and specificity were calculated. Results: Compared with the control group, the plasma expression levels of miR-181a-5p and caspase-1 in the ACI group were increased, and the expression level of Bcl-2 was reduced (all P<0.05). miR-181a-5p was positively correlated with caspase-1 (r=0.176, P=0.032) and negatively correlated with Bcl-2 (r=-0.209, P=0.011). The expression levels of plasma miR-181a-5p in patients with mild, moderate and severe ACI were (1.35±0.32), (1.79±0.20), and (2.34±0.59), respectively. After one-way analysis of variance, there were statistically significant differences between groups (F=32.001, P<0.01), the more severe the disease, the higher the expression level of miR-181a-5p in plasma. Compared with the good prognosis group, the poor prognosis group had higher age, NIHSS score on admission, miR-181a-5p and caspase-1 levels, but lower Bcl-2 levels (P<0.05). Multivariate analysis showed that age (OR=1.532), NIHSS score on admission (OR=1.832) and plasma miR-181a-5p (OR=3.111) level were independent influencing factors of poor prognosis in ACI patients (P<0.05). The AUC of plasma miR-181a-5p for predicting poor prognosis was 0.856 (95%CI: 0.815-0.886, P<0.01), and the sensitivity and specificity were 89.56% and 70.12%, respectively. Conclusion: The expression level of miR-181a-5p in the plasma of ACI patients was significantly increased, which has a certain value for the early assessment of ACI disease and prognosis. |
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