血肿周围脑组织miR-340-5p、PDCD4表达水平与高血压性脑出血病人预后的关系系

目的 探讨高血压脑出血血肿周围脑组织miR-340-5p、程序性细胞死亡蛋白4（PDCD4）表达的相关性及临床意义。方法 收集2016年9月至2020年9月手术切除的高血压性脑出血血肿周围脑组织217例，选择同期病理科尸检获取的正常脑组织标本50例作为对照。PCR检测脑组织miR-340-5p、PDCD4 mRNA水平。发病90 d用改良Rankin量表评分评估预后，0~2分为预后良好，3~5分为预后不良。结果 217例中，预后良好148例，预后不良69例。血肿周围脑组织miR-340-5p水平明显低于对照组（P<0.05），而PDCD4 mRNA水平明显高于对照组（P<0.05）。血肿周围脑组织miR-340-5p水平与PDCD4 mRNA水平呈明显负相关（r=-0.683，P<0.05）。预后不良组血肿周围脑组织miR-340-5p水平明显低于预后良好组（P<0.05），而PDCD4 mRNA水平明显高于预后良好组（P<0.05）。多因素logistic回归分析显示，血肿周围脑组织miR-340-5p水平降低、PDCD4 mRNA水平增高是高血压性脑出血预后不良的独立危险因素（P<0.05）。ROC曲线分析显示，血肿周围脑组织miR-340-5p水平预测预后不良的最佳截断值为0.665，曲线下面积为0.808（95%置信区间0.733~0.882），灵敏度、特异度分别为70.97%、71.05%；PDCD4 mRNA的最佳截断值为1.425，曲线下面积为0.834（95%置信区间0.775~0.894），灵敏度、特异度分别为71.08%、68.35%。结论 高血压性脑出血后，血肿周围脑组织miR-340-5p表达减少，可能通过负向调控PDCD4参与脑损伤病理过程。血肿周围脑组织miR-340-5p、PDCD4 mRNA表达水平对发病90 d预后评估具有一定临床价值。

Correlation of expression levels of miR-340-5p and PDCD4 in peripheral tissues of hemotoma with prognoses of patients with hypertensive intracerebral hemorrahge

Objective To explore the correlation of expression levels of miR-340-5p and PDCD4 in peripheral tissues of hemotoma with the prognoses of patients with hypertensive intracerebral hemorrahge (HICH). Methods The expression levels of miR-340-5p and PDCD4 mRNA were detected in peripheral tissues of hemotoma obtained from 217 patients with HICH who underwent surgery from September 2016 to September 2020 and in normal brain tissues obtained from 50 autopsies in the pathology department of our hospital using PCR. The prognosis was evaluated by the modified Rankin scale score at 90 days after the onset, with score of 0 to 2 as good prognosis and 3 to 5 as poor prognosis. Results Of 217 patients, 148 patients had a good prognosis and 69 had a poor prognosis. The level of miR-340-5p in peripheral tissues of hemotoma was significantly lower than that of the control group (P<0.05), and the level of PDCD4 mRNA was significantly higher than that of the control group (P<0.05). The level of miR-340-5p in peripheral tissues of hemotoma was significantly negatively correlated with the level of PDCD4 mRNA (r=-0.683, P<0.05). The level of miR-340-5p in peripheral tissues of hemotoma of patients with poor prognoses was significantly lower than that in patients with good prognoses (P<0.05), while the PDCD4 mRNA level was significantly higher than those with good prognoses (P<0.05). Multivariate logistic regression analysis showed that decrease of miR-340-5p and increase of PDCD4 mRNA in peripheral tissues of hemotoma were independent risk factors for poor prognosis of patients with HICH (P<0.05). ROC curve analysis showed that the best cut-off value for predicting poor prognosis of miR-340-5p and PDCD4 mRNA were 0.665 and 1.425, the areas under the curve were 0.808 (95% CI 0.733~0.882) and 0.834 (95% CI 0.775~0.894), the sensitivity and specificity were 70.97% and 71.05%, and 71.08% and 68.35%, respectively. Conclusions miR-340-5p aggravates the hypertensive intracerebral hemorrhage by down-regulation of PDCD4. The expression levels of miR-340-5p and PDCD4 mRNA in peripheral tissues of hemotoma have a certain clinical value for prognostic evaluation on the 90th day of onset.