标题：miRNA-23a-3p和TLR4在急性脑出血患者血清中的表达及临床意义

      作者：贺琦，王燕    贺琦，王燕西安宝石花长庆医院神经内科，陕西 西安 710201

      卷次： 2023年34卷15期

      【摘要】 目的 探究微小RNA-23a-3p (miR-23a-3p)、Toll样受体4 (TLR4)在急性脑出血(ACH)患者血清中的水平及其临床意义。方法 选取 2020年 1月至 2022年 3月西安宝石花长庆医院收治的 110例ACH患者为ACH组，并纳入同期110例健康体检者为对照组。采用实时荧光定量逆转录-聚合酶链反应(qRT-PCR)法测定两组受检者的血清miR-23a-3p表达水平，酶联免疫吸附法(ELISA)测定两组受检者的血清核因子κB (NF-κB)、TLR4、肿瘤坏死因子-α (TNF-α)水平；采用Pearson法分析ACH患者血清miR-23a-3p、TLR4水平与TNF-α、NF-κB的相关性；比较不同预后ACH患者一般资料及血清miR-23a-3p、TLR4、TNF-α、NF-κB水平；采用受试者工作特征曲线(ROC)分析血清miR-23a-3p、TLR4水平对ACH患者预后的评估价值。结果 ACH组患者血清miR-23a-3p、TLR4、TNF-α、NF-κB水平分别为2.29±0.67、(32.94±10.98) μg/L、(51.28±21.37) pg/mL、(17.34±6.19) ng/mL，明显高于对照组的 1.01±0.30、(17.46±5.82) μg/L、(20.31±8.47) pg/mL、(8.50±3.04) ng/mL，差异均有统计学意义(P<0.05)；ACH患者血清miR-23a-3p、TLR4水平与TNF-α、NF-κB均呈正相关(r=0.377、0.538、0.403、0.572，P<0.05)，且血清miR-23a-3p表达水平与TLR4也呈正相关(r=0.581，P<0.05)；预后不良组ACH患者NIHSS评分、脑出血体积、血清miR-23a-3p、TLR4、TNF-α、NF-κB水平明显高于预后良好组，差异均有统计学意义(P<0.05)；血清miR-23a-3p、TLR4预测ACH患者预后的曲线下面积(AUC)分别为0.857、0.868，截断值分别为2.37 μg/L、34.52 μg/L，敏感度分别为76.9%、78.8%，特异性分别为87.9%、86.2%；miR-23a-3p、TLR4联合预测ACH患者预后的AUC为0.941，敏感度为90.4%，特异性为89.7%。结论 ACH患者血清miR-23a-3p、TLR4水平较高，miR-23a-3p与TLR4呈正相关，且miR-23a-3p、TLR4联合检测可较好地预测ACH患者预后，为临床预测ACH患者预后提供新策略。
      【关键词】 急性脑出血；微小miR-23a-3p；Toll样受体4；预后；相关性
      【中图分类号】 R743.34 【文献标识码】 A 【文章编号】 1003—6350（2023）15—2135—05

Expression and clinical significance of miRNA-23a-3p and Toll-like receptor 4 in serum of patients with acutecerebral hemorrhage.
HE Qi, WANG Yan. Department of Neurology, Xi'an Baoshihua Changqing Hospital, Xi'an 710201,Shaanxi, CHINA
【Abstract】 Objective To explore the levels of microRNA-23a-3p (miR-23a-3p) and Toll-like receptor 4(TLR4) in the serum of patients with acute cerebral hemorrhage (ACH) and its clinical significance. Methods A totalof 110 ACH patients admitted to Xi'an Baoshihua Changqing Hospital from January 2020 to March 2022 were selectedas the ACH group, and 110 healthy subjects in the same period were included as the control group. Real-time quantita-tive reverse transcription-polymerase chain reaction (qRT-PCR) method was used to determine the expression level of se-rum miR-23a-3p in the two groups. Enzyme-linked immunosorbent assay (ELISA) was used to determine serum nucle-ar factor-κB (NF-κB), TLR4, and tumor necrosis factor-α (TNF-α) levels in the two groups. Pearson method was usedto analyze the correlation between serum miR-23a-3p, TLR4 levels and TNF-α, NF-κB in ACH patients. The generaldata and serum levels of miR-23a-3p, TLR4, TNF-α, and NF-κB in ACH patients with different prognosis were com-pared. Receiver operating characteristic (ROC) curve was used to analyze the serum miR-23a-3p, TLR4 levels in theevaluation of the prognosis of ACH patients. Results The serum levels of miR-23a-3p, TLR4, TNF-α and NF-κB inthe ACH group were 2.29±0.67, (32.94±10.98) μg/L, (51.28±21.37) pg/mL, (17.34±6.19) ng/mL, respectively, whichwere significantly higher than 1.01±0.30, (17.46±5.82) μg/L, (20.31±8.47) pg/mL, (8.50±3.04) ng/mL in the controlgroup (P<0.05). The serum levels of miR-23a-3p and TLR4 in ACH patients were positively correlated with TNF-α andNF-κB (r=0.377, 0.538, 0.403, 0.572, P<0.05), and the expression levels of serum miR-23a-3p were also positively cor-related with TLR4 (r=0.581, P<0.05). The NIHSS score, cerebral hemorrhage volume, serum miR-23a-3p, TLR4,TNF-α and NF-κB levels of ACH patients in the poor prognosis group were significantly higher than those in the goodprognosis group, and the differences were statistically significant (P<0.05). The area under the curve (AUC) of serummiR-23a-3p and TLR4 for predicting the prognosis of ACH patients was 0.857 and 0.868, with the cut-off value of2.37 μg/L and 34.52 μg/L, the sensitivity of 76.9% and 78.8%, respectively, and the specificity of 87.9% and 86.2%, re-spectively. The AUC of miR-23a-3p combined with TLR4 in predicting the prognosis of ACH patients was 0.941, withthe sensitivity of 90.4% and the specificity of 89.7%. Conclusion ACH patients have high levels of serum miR-23a-3pand TLR 4, and miR-23a-3p is positively correlated with TLR4. The combination of miR-23a-3p and TLR4 can betterpredict the prognosis of patients with ACH, and provide a new strategy for clinical prediction of the prognosis of patientswith ACH.
      【Key words】 Acute cerebral hemorrhage; MicroRNA-23a-3p; Toll-like receptor 4; Prognosis; Correlation