摘要
目的探讨血清miR-217-5p在出血性脑卒中患者中的表达水平及其临床意义。方法选取2019年5月至2021年5月邯郸市第一医院收治的出血性脑卒中患者135例作为观察组,另选取同时期健康体检者127例为对照组。采用实时荧光定量聚合酶链式反应法检测所有受试者血清miR-217-5p表达水平并对比;根据美国国立卫生研究院卒中量表(NIHSS)评分将观察组患者分为轻度、中度和重度,比较不同病情程度患者血清miR-217-5p表达水平;根据治疗后随访3个月的预后情况将观察组分为预后良好组和预后不良组,比较预后良好组和预后不良组血清miR-217-5p表达水平及一般资料;采用多因素Logistic回归分析法分析出血性脑卒中患者预后不良的影响因素,并绘制受试者工作特征(ROC)曲线分析血清miR-217-5p表达水平对出血性脑卒中患者预后情况的预测价值。结果观察组血清miR-217-5p表达水平低于对照组(t=37.182,P<0.05);观察组中度、重度患者血清miR-217-5p表达水平低于轻度者(P<0.05),重度者血清miR-217-5p表达水平低于中度者(P<0.05)。随访3个月,135例患者发生预后不良的有51例,发生率为37.78%;预后不良组血清miR-217-5p表达水平低于预后良好组(t=13.525,P<0.05);预后不良组年龄大于预后良好组(t=2.900,P<0.05),合并脑疝占比、白细胞介素-1β(IL-1β)、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)、NIHSS评分高于预后良好组(t=4.676、6.949、6.332、5.712、3.062、12.066,P<0.05),格拉斯哥昏迷指数(GCS)评分低于预后良好组(t=10.457,P<0.05)。经Logistic回归分析显示,年龄、合并脑疝、IL-1β、TNF-α、CRP、IL-6、NIHSS评分、GCS评分、miR-217-5p表达水平均是出血性脑卒中预后不良的影响因素(OR=5.073、3.009、5.801、5.392、5.223、5.109、7.294、7.621、0.685,P<0.05);ROC曲线结果显示,血清miR-217-5p表达水平预测出血性脑卒中患者预后不良的曲线下面积(AUC)、敏感度、特异度、阳性预测价值、阴性预测价值分别为0.832、86.27%、79.76%、72.13%、90.54%。结论出血性脑卒中患者血清miR-217-5p呈低表达,且该指标与预后密切相关,可作为预测出血性脑卒中患者预后的重要生化指标。
Objective To investigate the expression level and clinical significance of serum microRNA-217-5p(miR-217-5p)in patients with hemorrhagic stroke.Methods A total of 135 patients with hemorrhagic stroke admitted to Handan First Hospital from May 2019 to May 2021 were selected as the observation group,and 127 healthy subjects who underwent physical examinations during the same period were selected as the control group.The expressions of serum miR-217-5p in all subjects were detected by real-time fluorescence quantitative polymerase chain reaction and compared.According to the National Institutes of Health Stroke Scale(NIHSS)score,patients in the observation group were divided into mild,moderate and severe groups to compare the serum miR-217-5p expression levels in patients with different severity.The observation group was further divided into the good prognosis group and the poor prognosis group according to the prognosis of 3 months after treatment.The expression level of serum miR-217-5p and general information were compared between the good prognosis group and the poor prognosis group.Multivariate Logistic regression analysis was used to analyze the influencing factors of poor prognosis in patients with hemorrhagic stroke,and receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum miR-217-5p expression level for the prognosis of patients with hemorrhagic stroke.Results The expression level of serum miR-217-5p in the observation group was lower than that in the control group(t=37.182,P<0.05).The expression levels of serum miR-217-5p in moderate and severe patients in the observation group were lower than that in mild patients(P<0.05),and the expression of serum miR-217-5p in severe patients was lower than that in moderate patients(P<0.05).After 3 months of follow-up,poor prognosis occurred in 51 of 135 patients,with an incidence of 37.78%.The expression level of serum miR-217-5p in the poor prognosis group was lower than that in the good prognosis group(t=13.525,P<0.05).Patients’average age in the poor prognosis group was higher than that in the good prognosis group(t=2.900,P<0.05).In the poor prognosis group,the proportion of cerebral hernia,interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6),NIHSS scores were higher than those in the good prognosis group(t=4.676,6.949,6.332,5.712,3.062,12.066;P<0.05),and the Glasgow coma scale(GCS)score was lower than that in the good prognosis group(t=10.457,P<0.05).Logistic regression analysis showed that age,cerebral hernia,IL-1β,TNF-α,CRP,IL-6,NIHSS score,GCS score and miR-217-5p expression level were all influencing factors for the poor prognosis of hemorrhagic stroke(OR=5.073,3.009,5.801,5.392,5.223,5.109,7.294,7.621,0.685;P<0.05).ROC curve results showed that the area under the curve(AUC),sensitivity,specificity,positive predictive value and negative predictive value of serum miR-217-5p expression in predicting poor prognosis of patients with hemorrhagic stroke were 0.832,86.27%,79.76%,72.13%,90.54%,respectively.Conclusion Serum miR-217-5p in patients with hemorrhagic stroke is lowly expressed,and is closely related to the prognosis of the disease,making it an important biochemical marker to predict the prognosis of patients with hemorrhagic stroke.
作者
耿炜
周涛
李晓鹏
李建波
朱立艳
Geng Wei;Zhou Tao;Li Xiaopeng;Li Jianbo;Zhu Liyan(Department of Neurology,Handan First Hospital,Handan 056001,China)
出处
《心脑血管病防治》
2023年第11期18-22,31,共6页
CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT
基金
河北省邯郸市科学技术研究与发展计划项目(19422083010-7)。
