目的 探讨血清微小核糖核酸(miR)-193b-3p与动脉瘤性蛛网膜下腔出血(aSAH)病人不良预后的关系.方法 2019年1月1日至2021年12月1日前瞻性收集aSAH共159例,采用RT-PCR检测入院24h内血清miR-193b-3p水平.发病90 d,采用GOS评分评估预后,其中4~5分为预后良好,1~3分为预后不良.结果 159例中,预后良好153例,预后不良56例(35.2%),其中死亡39例.ROC曲线分析显示,入院24h内血清miR-193b-3p水平预测aSAH不良预后的曲线下面积为0.912(95%CI 0.870~0.954),最佳截断值为0.62,灵敏度和特异度分别为75.7%和94.6%.入院24h内血清miR-193b-3p水平与入院时Hunt-Hess分级呈明显负相关(r=-0.384,P<0.001),与入院时Fisher分级呈明显负相关(r=-0.200,P=0.011),与入院时GCS评分呈明显正相关(r=0.409,P<0.001).多因素logistic回归分析显示,入院24h内血清miR-193b-3p≥0.62是aSAH病人预后不良的独立危险因素(OR=3.148;95%CI 1.017~5.167;P<0.001).结论 本文结果提示入院24h内血清miR-193b-3p作为非侵入性生物标志物,不仅可以用于评估aSAH病人的病情严重程度,还可以在早期用于预测病人的预后.
Objective To investigate the relationship between serum miR-193B-3P on admition and poor prognosis of patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 159 patients with aSAH were prospectively collected from January 1,2019 to December 1,2021,and the serum miR-193b-3p level within 24 h after admission was detected by RT-PCR.GOS score was used to evaluate the prognosis 90 days after the onset,with a GOS score of 4~5 as good prognosis and a GOS score of 1~3 as poor prognosis.Results Of these 159 patients,153 patients had good prognosis,and 56(35.2%)poor prognosis(39 patients died).ROC curve analysis showed that the area under the curve of serum miR-193b-3p level within 24 h after admission to predict the poor prognosis of aSAH patients was 0.912(95%CI 0.870~0.954),the best cutoff value was 0.62,and the sensitivity and specificity were 75.7%and 94.6%,respectively.Serum miR-193b-3p levels within 24 h after admission were significantly negatively correlated with Hunt-Hess grade(r=-0.384,P<0.001)and Fisher grade on admission(r=-0.200,P=0.011),was significantly positive correlated with GCS score on admission(r=0.409,P<0.001).Multivariate logistic regression analysis showed that serum miR-193b-3p≥0.62 within 24 h after admission was an independent risk factor for poor prognosis of aSAH patients(OR=3.148;95%CI 1.017~5.167;P<0.001).Conclusions Our results suggest that serum miR-193b-3p within 24 h of admission,as a non-invasive biomarker,can not only be used to assess the severity of aSAH patients,but also can be used to predict the prognosis of patients with aSAH in the early stage.