摘要
目的探讨颅脑损伤(TBI)患者入院时外周血miR-130a和miR-132水平对病情严重程度的早期诊断价值,以及对重型颅脑损伤(s TBI)患者发病6个月预后的预测价值。方法选择在我院救治的158例TBI患者和30例健康志愿者作为对照组纳入研究,根据格拉斯昏迷评分(GCS),将TBI患者分为轻度(m TBI)组、中度(ms TBI)组和重度(s TBI)组。采用基因芯片技术筛选四组受试对象有表达差异的miRNAs,并筛选靶基因明确的miRNAs进行荧光定量PCR验证。随访6个月,根据格拉斯预后评分(GOS),将患者分为预后良好组和预后不良组。建立受试者工作特征(ROC)曲线确定外周血miRNAs对预后诊断的临界值。结果经基因芯片分析选择miR-130a和miR-132作为目标miRNA,经荧光定量PCR检测,与对照组受试者相比,三组TBI患者外周血中miR-130a表达均显著上调,同时miR-132表达量显著下调(均P<0.05)。而且以s TBI组患者外周血miR-130a水平为最高,miR-132水平为最低。经Spearman相关性分析,TBI患者入院时GCS评分和外周血miR-130a表达呈负相关性(rs=-0.79,P<0.05),而和miR-132表达呈正相关性(rs=0.74,P<0.05)。根据6个月随访结果,39例患者预后良好,26例患者预后不良。预后良好组患者外周血miR-130a水平低于预后不良组患者(P<0.05),同时miR-132水平高于预后不良组患者(P<0.05)。经ROC曲线分析,入院时外周血miR-130a和miR-132水平对s TBI患者6个月预后预测的ROC曲线下面积(area under curve,AUC)分别为0.74(95%CI 0.57~0.87)、0.70(95%CI 0.63~0.85),差异无统计学意义(P>0.05)。而miR-130a和miR-132联合预测m TBI患者预后的ROC曲线AUC明显高于单项指标(P<0.05)。结论TBI患者入院时外周血miR-130a和miR-132水平可早期评估疾病严重程度,并且可作为s TBI患者近6个月预后的早期预测指标。
Objective To explore the expression of serum miR-130 a and miR-132 in patients with traumatic brain injury(TBI)and the predictive value on short-time(6 months)prognosis of patients with severe traumatic brain injury(s TBI).Methods 158 TBI patients were divided into m TBI group,ms TBI group and s TBI group according to Glasgow coma score,and30 healthy volunteers were selected as control group.Using gene chip technology to filtrate different miRNAs in four groups,then miRNAs with target gene were validated by fluorogenic quantitative PCR.According to Glasgow outcome score(GOS)after injury 6 months,TBI patients were divided into patients with good prognosis and patients with poor prognosis.Receiver operating characteristic(ROC)curve was built to analyze the predictive value of serum miRNAs at admission on short-time prognosis of patients.Results Choosing miR-130 a and miR-132 as target miRNA through gene chip technology analysis.Validated by fluorogenic quantitative PCR,the expression of miR-130 a in m TBI,ms TBI,s TBI patients were increased gradually(P<0.05),and the expression of miR-132 in m TBI,ms TBI,s TBI patients were declined gradually(P<0.05).And the s TBI patients had highest level of miR-130 a and lowest level of miR-132 than these of m TBI and ms TBI patients(all P<0.05).Spearman correlation analysis showed that the GCS score and miR-130 a was negative related(rs=-0.79,P<0.05),while GCS score and miR-132 was positive related(rs=0.74,P<0.05).After followed up 6 months,there were 39 patients with good prognosis and 26 patients with poor prognosis.The level of miR-130 a in good prognosis group was lower than that in poor prognosis group,the level of miR-132 in good prognosis group was higher than that in poor prognosis group(P<0.05).The area under ROC curve of miR-130 a and miR-132 at admission on prediction of prognosis of s TBI patients were 0.74(95%CI:0.57~0.87)and 0.70(95%CI:0.63~0.85),which was lower than combined predictive value of miR-130 a and miR-132(P<0.05).Conclusions Serum miR-130 a and miR-132 at admission is closely related with the severity of disease,which could be the early sensitive predictors of prognosis in s TBI patients in 6 moths.
作者
路伟
李钢
周奋
刘仲海
LU Wei;LI Gang;ZHOU Fen(People’s Hospital of Baoting Li and Miao Autonomous County,Hainan 572300,China)
出处
《心脑血管病防治》
2019年第4期299-303,共5页
CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT
