血清miRNA-494和miRNA-125a表达在腰椎间盘退变疾病中的临床应用

［摘要］ 目的 探讨血清miRNA-494和miRNA-125a表达与腰椎间盘退变程度的相关性。 方法 选择腰椎间盘膨出或突出患者45例为退变组，下腰痛患者42例为对照组，所有患者均行腰椎MRI，通过磁共振弥散加权成像技术分析腰椎间盘退变程度与椎间盘Pfirrmann(PM)分级的关系。 结果 对照组共检查126个椎间盘，其中分级在Ⅰ级和Ⅱ级（正常）99个椎间盘，占78.6%（99/126）, Ⅲ级、Ⅳ级和Ⅴ级27个椎间盘，占21.4%（27/126）；退变组共检查135个椎间盘，其中分级在Ⅰ级和Ⅱ级（正常）17个椎间盘，占12.6%（17/135），Ⅲ级、Ⅳ级和Ⅴ级118个椎间盘，占87.4%（118/135）。2组PM分级构成比差异有统计学意义（P＜0.05）, 退变组表观弥散系数(apparent diffusion coefficient，ADC）值低于对照组（P＜0.05）。退变组血清miRNA-125a较对照组明显降低，血清miRNA-494水平较对照组明显升高（P＜0.05）。退变组miRNA-125a表达水平与ADC值呈正相关（r=0.853，P＜0.01），miRNA-494表达水平与ADC值呈负相关（r=-0.897，P＜0.01）。血清miRNA-125a和miRNA-494的ROC曲线分析显示miRNA-125a和miRNA-494的曲线下区域面积分别为0.893（95%CI=0.815～0.971，P＜0.01）、0.852（95%CI=0.762～0.932，P＜0.01），敏感度分别为87.9%和93.7%，特异度分别为77.0%和67.7%，准确度分别为80.0%和77.7%，阳性预测值分别为92.3%和92.1%，阴性预测值分别为81.8%和76.9%。 结论 血清miRNA-494和miRNA-125a的表达可能与椎间盘退变疾病的发病机制有关，检测其表达水平可为椎间盘退变疾病的早期诊断及治疗提供基因依据。

Clinical application of serum miRNA-494 and miRNA-125a expression in lumbar intervertebral disc degeneration disease

［Abstract］ Objective To investigate the correlation of the serum expression of microRNA-494 and microRNA-125a with the degree of lumbar intervertebral disc degeneration. Methods Forty-five patients with prolapse or protrusion of lumbar intervertebral disc were selected as degeneration group and 42 patients with low back pain as control group. All patients underwent lumbar MRI. The relationship between the degree of degeneration of lumbar intervertebral disc and Pfirrmann(PM) grade of intervertebral disc was analyzed via diffusion weighted magnetic resonance imaging(DWI). Results In the control group, 126 intervertebral discs were examined, of which 99 were in grade Ⅰ and Ⅱ(normal), accounting for 78.6%(99/126), 27 were in grade Ⅲ, Ⅳ and Ⅴ, accounting for 21.4%(27/126).135 intervertebral discs were examined in the degeneration group, of which 66 were in grade Ⅰ and Ⅱ(normal), accounting for 12.6%(17/135),118 were in grade Ⅲ, Ⅳ and Ⅴ, accounting for 87.4%(118/135).There was significant difference in PM grading constituent ratio between two groups(P＜ 0.05), and the apparent diffusion coefficient(ADC) value in the degenerative group was lower than that in the control group(P＜0.05).The serum level of microRNA-125a in degenerative group was significantly lower whereas of serum microRNA-494 was significantly higher than that in control group(P＜0.05).The expression level of microRNA-125a in degenerative group was positively correlated with ADC value(r=0.853, P＜0.01), and the expression level of microRNA-494 was negatively correlated with ADC value(r=-0.897, P＜0.01).ROC curve analysis of microRNA-125a and microRNA-494 in serum showed that the area under the curve of microRNA-125a and microRNA-494 was 0.893(95%CI=0.815-0.971, P＜0.01) and 0.852(95%CI=0.762-0.932, P＜0.01), respectively. The sensitivity was 87.9% and 93.7%, specificity was 77.0% and 67.7%, accuracy was 80.0% and 77.7%, positive predictive value was 92.3% and 92.1%, negative predictive value was 81.8% and 76.9%, respectively. Conclusion The expression of miRNA-494 and miRNA-125a in serum may be related to the pathogenesis of lumbar disc degeneration disease. Detecting their expression levels can provide a genetic basis for early diagnosis and treatment of lumbar disc degeneration disease.