摘要
目的探讨颅内动脉瘤患者血清缺氧诱导因子-1α(hypoxia-inducible factor-1α,HIF-1α)、半胱氨酸天冬氨酸蛋白水解酶-3(cysteine aspartate protein hydrolase-3,Caspase-3)、微小RNA-143(microRNA-143,miR-143)水平与动脉瘤破裂的关系。方法143例颅内动脉瘤患者作为病例组,根据颅内动脉瘤破裂与否分为未破裂组(n=95)和破裂组(n=48),另选取同期健康体检人群138例作为对照组,收集各组受检者的一般资料(年龄、性别及体质量指标);抽取病例组患者入院日、对照组体检者体检日空腹肘静脉血离心,采用酶联免疫吸附试验和实时荧光定量PCR检测各组受检者血清HIF-1α、Caspase-3及miR-143水平;随访病例组患者术后3个月,采用CT血管造影检查患者的动脉瘤影像特征(动脉瘤标准化表面最大压力、瘤体宽径、形状不规则占比、载瘤动脉宽度、低剪切力面积比值、动脉瘤标准化表面平均压力、瘤体长径、瘤径宽度、瘤体最长径、平均壁面剪切力及动脉瘤位置)并判断颅内动脉瘤破裂与否,采用多因素logistic分析病例组患者颅内动脉瘤破裂的影响因素,采用Spearman相关分析和ROC曲线分析病例组患者血清HIF-1α、Caspase-3、miR-143水平与颅内动脉瘤破裂的相关性及预警价值。结果病例组患者血清Caspase-3、HIF-1α高于对照组,miR-143水平低于对照组(P<0.05);破裂组颅内动脉瘤患者血清miR-143水平和瘤体宽径低于未破裂组,血清HIF-1α、Caspase-3及低剪切力面积比值、瘤体最长径、形状不规则占比、瘤体长径、平均壁面剪切力水平高于未破裂组(P<0.05);logistic分析结果显示,血清Caspase-3、miR-143、HIF-1α及低剪切力面积比值、瘤体宽径、瘤体长径、平均壁面剪切力、瘤体最长径、形状不规则是颅内动脉瘤破裂的影响因素(P<0.05);Spearman相关分析结果显示,血清miR-143与患者颅内动脉瘤破裂呈负相关(P<0.05),血清Caspase-3、HIF-1α与患者颅内动脉瘤破裂呈正相关(P<0.05);血清miR-143、Caspase-3及HIF-1α预测颅内动脉瘤破裂的曲线下面积(AUC)分别为0.716、0.689及0.702,3者联合预测颅内动脉瘤破裂的AUC为0.802大于单独指标预测。结论血清高HIF-1α、Caspase-3水平及低miR-143水平是颅内动脉瘤破裂的影响因素,且3者联合预测价值更高。
Objective To investigate the relationship between serum hypoxia-inducible factor-1α(HIF-1α),cysteine aspartate protein hydrolase-3(Caspase-3),and microRNA-143(miR-143)levels and rupture of intracranial aneurysms in patients with intracranial aneurysms.Methods A total of 143 patients with intracranial aneurysms were divided into unruptured group(n=95)and ruptured group(n=48),and another 138 cases attending health checkups in the same hospital were selected as the control group.The general information of all subjects was collected,including age,gender,and body mass indexes.Fasting elbow vein blood of the patients was extracted and centrifuged.Serum HIF-1α,Caspase-3,and miR-143 levels were detected by enzyme-linked immunosorbent assay and real-time fluorescence quantitative PCR.Three months after the surgery,CT angiography was used to examine the aneurysm imaging features(aneurysm standardized surface maximum pressure,aneurysm width and diameter,the percentage of irregular shapes,the width of the aneurysm-carrying arteries,and the ratio of the area of low shear force,aneurysm standardized surface mean pressure,aneurysm length diameter,aneurysm width,aneurysm longest diameter,mean wall shear force and aneurysm location),and to determine whether intracranial aneurysms were ruptured or not.We analyzed the factors influencing intracranial aneurysm rupture of the patients by using multifactorial logistic regression,and Spearman's correlation analysis and ROC curve were used to analyze the correlations between serum HIF-1α,Caspase-3,miR-143 levels and intracranial aneurysm rupture.Results Higher levels of serum Caspase-3 and HIF-1αbut lower miR-143 levels were found in the case group than control group(P<0.05);serum miR-143 levels and tumor width diameter were lower in the ruptured group compared with the unruptured group of intracranial aneurysm patients;serum HIF-1α,Caspase-3,the ratio of low-shear area,the longest diameter of the tumor body,the percentage of the irregular shape,the tumor body length diameter,mean wall shear level were higher than that of the unruptured group(P<0.05);logistic analysis showed that serum Caspase-3,miR-143,HIF-1α,and low shear area ratio,aneurysm width,aneurysm length,mean wall shear,aneurysm longest diameter,and shape irregularity were the risk factors of ruptured intracranial aneurysms(P<0.05);correlation analysis showed that serum miR-143 was negatively correlated with intracranial aneurysm rupture in patients(P<0.05),and serum Caspase-3 and HIF-1αwere positively correlated with intracranial aneurysm rupture in patients(P<0.05);serum miR-143,Caspase-3,and HIF-1αpredicted the rupture of intracranial aneurysms with an area under the curve(AUC)of 0.716,0.689,and 0.702,respectively,and the AUC for the combined prediction of intracranial aneurysm rupture was 0.802.Conclusion High levels of HIF-1α,Caspase-3 and low levels of miR-143 were independent risk factors for intracranial aneurysm rupture,and the combined prediction value of the three factors was higher.
作者
刘文涛
王丽
党庆浩
张宏泽
LIU Wentao;WANG Li;DANG Qinghao;ZHANG Hongze(Department of Neurosurgery,Jiaozhou Central Hospital,Qingdao 266300,Shandong,China;Department of Neurology,the 8th People's Hospital of Qingdao,Qingdao 266000,Shandong,China;Department of Neurology,Jiaozhou Central Hospital,Qingdao 266300,China)
出处
《贵州医科大学学报》
2025年第8期1230-1236,共7页
Journal of Guizhou Medical University
基金
青岛市医药卫生科研指导项目(2022-WJZD125)。
