远程缺血后适应干预对急性脑梗死患者血清miR-21、miR-24水平和神经功能的影响  

The effect of remote ischemia postconditioning on fluctuation of serum microRNA-21 and microRNA-24 in patients with acute cerebral infarction following intravenous thrombolysis

作　　者：范佳[1] 查俊杰 钱丽娜[1] 许春阳[1] 

机构地区：[1]江苏省常熟市第一人民医院急诊科,224500

出　　处：《疑难病杂志》2017年第11期1085-1088,1092,共5页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的观察远程缺血后适应(RIPC)对急性脑梗死(ACI)患者溶栓前后外周血miR-21、miR-24水平和神经功能的影响。方法连续性纳入2015年1月-2017年1月于常熟市第一人民医院住院治疗的急性脑梗死患者64例,随机数字表法分为RIPC组和对照组,每组32例。对照组给予静脉溶栓和常规脑梗死治疗,RIPC组在溶栓后给予RIPC治疗,其他方案同对照组。分别于溶栓前(T0),溶栓后24 h(T1)、1周(T2)和2周(T3)4个时间点检测血清miR-21和miR-24浓度,并进行NIHSS和Barthel评分。结果治疗后2组患者血清miR-21均下降(RIPC组:F=3.178,P=0.019;对照组:F=3.519,P=0.012),而miR-24均上升(RIPC组:F=4.288,P=0.004;对照组:F=4.161,P=0.005),RIPC组T2和T3时间点miR-21水平低于对照组(T2:t=2.446,P=0.020;T3:t=2.557,P=0.016),而miR-24高于对照组(T2:t=2.394,P=0.002;T3:t=2.597,P=0.014);2组NIHSS评分下降(RIPC组:F=3.947,P=0.006;对照组:F=3.095,P=0.022),而Barthel评分上升(RIPC组:F=2.669,P=0.040;对照组:F=3.521,P=0.012),RIPC组于T2和T3,时间点NIHSS评分明显低于对照组(T2:t=2.754,P=0.010;T3:t=2.865,P=0.007),而Barthel分高于对照组(T2:t=2.643,P=0.013;T3:t=2.976,P=0.006)。溶栓与miR-21水平(Δ4和Δ5)和NIHSS评分(Δ4和Δ5)呈负相关,与miR-24(Δ4和Δ5)和Barthel分值(Δ4和Δ5)呈正相关(P<0.05)。溶栓+RIPC与miR-21(△4和△5)和NIHSS评分(△4和△5)呈负相关,与miR-24(△4和△5)和Barthel分值(△4和△5)呈正相关(P<0.05),且相关性均明显高于单纯溶栓患者。结论 RIPC有助于提高ACI患者溶栓后神经功能恢复,可能与调控miR-21和JmiR-24有关。Objective To evaluate the effect of remote ischemia post conditioning(RIPC) on fluctuation of serum microRNA-21 and microRNA-24 in patients with acute cerebral infarction(ACI) following intravenous thrombolysis(IT).Methods Sixty-four ACI patients were enrolled in this study and divided into two groups : RIPC group and control group. The patients in control group were giving IT combining normal cerebral infarction treatment. On that basis, the patients in RIPC group were receiving RIPC. The levels of serum miRNA( miR-21 and miR-24) and neurological assessment( NIHSS and Barthel) were measured on four points: before IT(TO), 24 h(T1), 1 week(T2) and 2 week(T3) after IT. Results The levels of serum miR-21 were significantly reduced after treatment in both RIPC group and control group( RIPC group: F =3. 178, P =0.019;control group: F =3.519, P =0.012), while levels of miR-24 were significantly increased(RIPC group: F =4.288, P = 0.004;control group: F =4.161, P =0.005). On both T2 and T3, the levels of serum miR-21 in RIPC group were lower than those in control group(T2: t =2.446, P =0.020;T3: t =2.557, P =0.016), while levels of serum miR-24 were higher(T2: t =2.394, P =0.002;T3: t=2.597, P =0.014). The levels of NIHSS score were significantly reduced after treatment in both RIPC group and control group(RIPC group: F =3. 947, P =0. 006; control group:F = 3.095, P =0.022), while levels of Barthel score were significantly increased(RIPC group: F =2. 669, P =0. 040;control group: F =3.521, P =0.012). On both T2 and T3, the levels of NIHSS score in RIPC group were lower than those in control group(T2: t =2. 754, P =0.010;T3 : t =2. 865,P =0.007),while levels of Barthel score were higher(T2: t =2.643, P =0. 013;T3: t =2.916, P =0.006). Correlation analysis showed that RIPC + IT was negatively associated with both miR-21 and NIHSS, and positively related with miR-24 and Barthel score, which R value were all higher than those with single IT treatment. Conclusion The RIPC may increase the neurological recovery in ACI patient

关 键 词：远程缺血后适应 脑梗死 急性 微小RNA-21 微小RNA-24 

分 类 号：R743.33[医药卫生—神经病学与精神病学]