血清miR-200c和氧化型低密度脂蛋白在急性脑梗死早期诊断和预后评估中的临床价值

目的探究血清微小RNA-200c(miR-200c)、氧化型低密度脂蛋白(ox-LDL)对急性脑梗死(ACI)早期诊断及预后评估的价值。方法选取2017年11月至2020年12月本院收治的ACI患者167例为ACI组,另选取同期体检健康者167例为对照组。对ACI患者随访3个月,依据生活能力评分量表(MRS)评分分为预后良好组(MRS评分≤2分,122例)和预后不良组(MRS评分>2分,45例);比较ACI组、对照组血清miR-200c、ox-LDL水平;采用Pearson相关法分析ACI患者血清miR-200c与ox-LDL的相关性;对不同预后的ACI患者一般资料及血清miR-200c、ox-LDL水平进行单因素分析;采用多因素Logistic回归分析ACI患者预后的危险因素;利用受试者工作特征(ROC)曲线分析血清miR-200c、ox-LDL水平对ACI的早期诊断及ACI患者预后的评估价值。结果ACI组患者血清miR-200c、ox-LDL水平高于对照组miR-200c:1.86±0.63 vs.1.03±0.35,ox-LDL(mg/L):513.76±172.25 vs.325.48±110.49,P<0.05];ACI患者血清miR-200c与ox-LDL呈正相关(P<0.05);预后不良组ACI患者年龄大于预后良好组(岁:70.14±9.22 vs.65.06±8.37,P<0.05),发病至治疗时间长于预后良好组(h:5.97±0.75 vs.2.60±0.54,P<0.05),血清miR-200c、ox-LDL、美国国立卫生研究院卒中量表(NIHSS)评分高于预后良好组(P<0.05);年龄、NIHSS评分、miR-200c、ox-LDL、发病至治疗时间是影响ACI患者预后的危险因素(P<0.05);血清miR-200c、ox-LDL早期诊断ACI的曲线下面积(AUC)分别为0.867、0.850,截断值分别为1.44、431.09 mg/L,敏感度分别为77.2%、74.3%,特异度分别为88.6%、89.8%;血清miR-200c、ox-LDL评估ACI患者预后的AUC分别为0.874、0.868,截断值分别为2.13、582.06 mg/L,敏感度分别为75.6%、77.8%,特异度均为89.3%;血清miR-200c、ox-LDL联合早期诊断ACI、评估ACI患者预后的AUC分别为0.936、0.957,敏感度分别为91.0%、95.6%,特异度分别为86.2%、82.0%。结论血清miR-200c、ox-LDL均可早期诊断ACI、评估ACI患者预后,且miR-200c与ox-LDL联合可更好地早期诊断ACI、评估ACI患者预后。

Study on the clinical value of serum miR-200c and ox-LDL in the early diagnosis and prognostic evaluation of acute cerebral infarction

Objective To explore the value of serum microRNA-200c(miR-200c)and oxidized low-density lipoprotein(ox-LDL)in the early diagnosis and prognostic evaluation of acute cerebral infarction(ACI).Methods A total of 167 ACI patients admitted to our hospital from November 2017 to December 2020 were selected as the ACI group,and 167 healthy patients during the same period were selected as the control group.ACI patients were followed up for 3 months,and they were divided into a good prognosis groupthe modified Rankin scale(MRS)score≤2 points,122 cases]and a poor prognosis group(MRS score>2 points,45 cases)according to the MRS score;the serum miR-200c and ox-LDL levels were compared between the ACI group and the control group;Pearson correlation method was used to analyze the correlation between serum miR-200c and ox-LDL in ACI patients;Univariate analysis was performed on the general data and serum levels of miR-200c and ox-LDL in ACI patients with different prognosis;Multivariate Logistic regression was used to analyze the risk factors for the prognosis of ACI patients;the receiver operating characteristic(ROC)curve was used to analyze the value of serum miR-200c and ox-LDL levels in the early diagnosis of ACI and the prognosis of ACI patients.Results The serum levels of miR-200c and ox-LDL in the ACI group were higher than those in the control groupmiR-200c:1.86±0.63 vs.1.03±0.35,ox-LDL(mg/L):513.76±172.25 vs.325.48±110.49,P<0.05];the serum miR-200c in ACI patients was positively correlated with ox-LDL(P<0.05);the ACI patients were older in the poor prognosis group than in the good prognosis group(years:70.14±9.22 vs.65.06±8.37,P<0.05);the time from onset to treatment was longer than in the good prognosis group(h:5.97±0.75 vs.2.60±0.54,P<0.05);the serum miR-200c,ox-LDL,and the National Institutes of Health Stroke Scale(NIHSS)score were higher than in the good prognosis group(P<0.05).Age,NIHSS score,miR-200c,ox-LDL,and the time from onset to treatment were risk factors which affected the prognosis of ACI patients(P<0.05).The area under the curve(AUC)of serum miR-200c and ox-LDL for early diagnosis of ACI were 0.867 and 0.850,respectively.The cut-off values were 1.44 mg/L and 431.09 mg/L,respectively.The sensitivity was 77.2%and 74.3%,and the specificity was 88.6%and 89.8%.Serum miR-200c and ox-LDL predicted the prognosis of ACI patients with AUC of 0.874 and 0.868,cut-off values of 2.13 mg/L and 582.06 mg/L,the sensitivity of 75.6%and 77.8%,and the specificity of both 89.3%.The AUC of serum miR-200c combined with ox-LDL for early diagnosis of ACI and the prognosis of ACI patients were 0.936 and 0.957,the sensitivity was 91.0%and 95.6%,and the specificity was 86.2%and 82.0%,respectively.Conclusions Both miR-200c and ox-LDL can diagnose early ACI and evaluate the prognosis of ACI patients,and the combination of miR-200c and ox-LDL can better diagnose ACI early and evaluate the prognosis of ACI patients.