摘要
目的 探讨外伤性颅脑损伤患者外周血miRNA-124表达水平及其与预后的相关性。方法 回顾性选取2020年10月至2022年4月海南西部中心医院神经外科收治的外伤性颅脑损伤患者60例作为研究对象,按入院格拉斯哥昏迷量表(GCS)评分将其分为轻度损伤组(GCS评分13~15分,n=12),中度损伤组(GCS评分9~12分,n=27),重度损伤组(GCS评分3~8分,n=21),同期纳入30名健康体检者作为对照组。比较4组研究对象一般情况、GCS评分以及外周血miRNA-124表达水平的差异,将颅脑损伤患者分为预后不良组和预后良好组,对所有相关指标进行单因素分析,以单因素分析中差异有统计学意义的指标为自变量代入多因素Logistic回归模型中获得颅脑损伤患者预后不良的独立预测因素,绘制miRNA-124预测颅脑损伤患者预后不良的受试者工作特征(ROC)曲线,获得最佳诊断截点,分析miRNA-124对颅脑损伤患者预后不良预测效能。结果 4组研究对象GCS评分和miRNA-124比较,差异均有统计学意义(P<0.05),且随着颅脑损伤程度的加重,GCS评分呈现下降趋势,miRNA-124呈现上升趋势。单因素分析结果显示,预后不良组入院GCS评分和平均动脉压均低于预后良好组,而降钙素原、白细胞计数、血糖以及miRNA-124均高于预后良好组,差异均有统计学意义(P<0.05)。多因素分析结果显示,入院GCS评分、降钙素原、血糖以及miRNA-124为影响颅脑损伤患者预后的独立预测因素,入院GCS评分为独立保护因素,降钙素原、血糖以及miRNA-124为独立危险因素,其中miRNA-124每增加1个单位,颅脑损伤患者预后不良的风险增加0.894倍(OR=1.894,95%CI:1.513~2.117,P=0.011)。Pearson相关性分析显示,颅脑损伤患者外周血miRNA-124表达水平与降钙素原、白细胞计数以及血糖呈明显正相关(P<0.05),而与入院GCS评分和平均动脉压呈明显负相关(P<0.05)。ROC结果显示,以3.5为最佳诊断截点,miRNA-124预测颅脑损伤患者预后不良的曲线下面积为0.815(95%CI:0.772~0.863),敏感度为85.4%,特异度为80.8%。结论 外伤性颅脑损伤患者外周血miRNA-124表达水平明显升高,外周血miRNA-124表达水平可用于评估这类患者预后,敏感度和准确度较高,当miRNA-124≥3.5时提示患者预后不良。
Objective To investigate the expression level of miRNA-124 in peripheral blood of patients with traumatic craniocerebral injury and its correlation with prognosis.Methods Sixty patients with traumatic craniocerebral injury were included as the study objects and divided into mild injury group(GCS score 13-15,n=12),moderate injury group(GCS score 9-12,n=27),and severe injury group(GCS score 3-8,n=21)based on admission Glasgow coma scale(GCS)score,and 30 healthy subjects were included as the control group at the same time.The differences of general condition,GCS score and peripheral blood miRNA-124 expression level of the four groups were compared.The patients with craniocerebral injury were divided into the poor prognosis group and the good prognosis group.Univariate analysis was performed on all relevant indicators.The statistically significant indicators in the univariate analysis were substituted into the multivariate Logistic regression model to obtain independent predictors of poor prognosis in craniocerebral injury patients.Receiver operating characteristic(ROC)curve of miRNA-124 in predicting poor prognosis of patients with craniocerebral injury was plotted to obtain the optimal diagnostic cut-off point,and the predictive efficacy of miRNA-124 in predicting poor prognosis of patients with craniocerebral injury was analyzed.Results The GCS scores and miRNA-124 scores of the four study groups were compared,and the differences were statistically significant(P<0.05).As the severity of brain injury worsened,the GCS scores showed a downward trend,while miRNA-124 showed an upward trend.Univariate analysis showed that GCS score and mean arterial pressure in poor prognosis group were significantly lower than those in good prognosis group,while procalcitonin,white blood cell count,blood glucose and miRNA-124 were significantly higher than those in good prognosis group,and the differences were statistically significant(P<0.05).Multivariate analysis showed that,admission GCS score,procalcitonin,blood glucose and miRNA-124 were independent predictors of prognosis in patients with craniocerebral injury,admission GCS score was independent protective factor,procalcitonin,blood glucose and miRNA-124 were independent risk factors,in which every 1 unit increase of miRNA-124,patients with craniocerebral injury had a 0.894-fold increased risk of poor prognosis(OR=1.894,95%CI:1.513-2.117,P=0.011).Pearson correlation analysis showed that miRNA-124 expression level in peripheral blood of patients with craniocerebral injury was significantly positively correlated with procalcitonin(P<0.05),white blood cell count and blood glucose,while significantly negatively correlated with GCS score and mean arterial pressure on admission(P<0.05).ROC results showed that the area under the curve of miRNA-124 for predicting poor prognosis in patients with craniocranial injury was 0.815(95%CI:0.772-0.863),the sensitivity was 85.4%,and the specificity was 80.8%with 3.5 as the optimal diagnostic cut-off point.Conclusion The expression level of miRNA-124 in peripheral blood of patients with traumatic craniocerebral injury is significantly increased,which can be used to evaluate the prognosis of patients with high sensitivity and accuracy.When miRNA-124≥3.5,it indicates poor prognosis of patients.
作者
王上桥
孙占玉
梁定兴
吴运桥
WANG Shang-qiao;SUN Zhan-yu;LIANG Ding-xing(Department of Neurosurgery,Hainan Western Central Hospital,Danzhou Hainan 571700,China)
出处
《临床和实验医学杂志》
2023年第13期1363-1366,共4页
Journal of Clinical and Experimental Medicine
基金
海南省医药卫生科研项目(编号:20A200016)。
