血清microRNA-27a、核因子-κB与动脉瘤性蛛网膜下腔出血患者介入栓塞治疗疗效的关系

The relationship between serum microRNA-27a and NF-κB and the therapeutic efficacy of endovascular embolization in patients with aneurysmal subarachnoid hemorrhage

摘要:

目的 探讨血清microRNA-27a（miR-27a）、核因子-κB（NF-κB）与动脉瘤性蛛网膜下腔出血患者介入栓塞治疗疗效的关系。方法 回顾性分析2021年4月—2023年4月在枣庄市立医院接受介入治疗的162例动脉瘤性蛛网膜下腔出血患者的病历资料，术后2周评估疗效并分为有效组和无效组，比较两组患者的血清miR-27a、NF-κB水平，筛查动脉瘤性蛛网膜下腔出血患者介入栓塞治疗效果的影响因素，分析血清miR-27a、NF-κB对动脉瘤性蛛网膜下腔出血患者介入栓塞治疗效果的评估价值。结果 162例动脉瘤性蛛网膜下腔出血患者中，显效62例，有效78例，无效22例。两组患者性别、年龄、体质量指数、高血压家族史、动脉瘤直径、动脉瘤颈宽、动脉瘤位置、发病至介入栓塞治疗时间、Hunt-Hess分级、血管内皮生长因子、一氧化氮合酶及内皮素-1比较，经χ²/t 检验，差异均无统计学意义（P >0.05）。无效组患者颅脑CT Fisher Ⅲ～Ⅳ级占比高于有效组（P <0.05），NF-κB、miR-27a相对表达量高于有效组（P <0.05）。多因素逐步Logistic回归分析结果显示：颅脑CT Fisher分级［O^R=4.513（95% CI：1.801，11.304）］、NF-κB相对表达量［O^R=4.406（95% CI：1.759，11.036）］和miR-27a相对表达量［O^R=4.491（95% CI：1.793，11.248）］是动脉瘤性蛛网膜下腔出血患者介入栓塞治疗无效的危险因素（P <0.05）。受试者工作特征曲线分析结果显示，血清miR-27a、NF-κB和联合预测动脉瘤性蛛网膜下腔出血患者介入栓塞治疗效果的敏感性分别为67.9%（95% CI：0.541，0.759）、60.3%（95% CI：0.529，0.714）、72.5%（95% CI：0.641，0.816），特异性分别为77.1%（95% CI：0.681，0.863）、84.2%（95% CI：0.752，0.937）、96.1%（95% CI：0.814，0.998），曲线下面积分别为0.746（95% CI：0.631，0.854）、0.735（95% CI：0.629，0.851）、0.851（95% CI：0.772，0.958）。结论 血清miR-27a和NF-κB的异常表达与动脉瘤性蛛网膜下腔出血患者经血管介入栓塞术治疗的疗效反应相关。联合检测血清miR-27a与NF-κB可提高对动脉瘤性蛛网膜下腔出血患者介入栓塞治疗效果的预测价值。

Abstract:

Objective To investigate the relationship between serum microRNA-27a (miR-27a) and nuclear factor-kappa B (NF-κB) and the therapeutic efficacy of endovascular embolization in patients with aneurysmal subarachnoid hemorrhage.Methods A retrospective analysis was conducted on medical records of 162 patients with aneurysmal subarachnoid hemorrhage who underwent endovascular treatment in Zaozhuang Municipal Hospital from April 2021 to April 2023. Based on the efficacy assessment results conducted two weeks after the operation, patients were divided into effective and ineffective groups. Serum levels of miR-27a and NF-κB were compared between the two groups to screen factors affecting the therapeutic efficacy of endovascular embolization in patients with aneurysmal subarachnoid hemorrhage. The value of serum miR-27a and NF-κB for assessing the therapeutic efficacy of endovascular embolization in patients with aneurysmal subarachnoid hemorrhage was analyzed.Results Among the 162 patients with aneurysmal subarachnoid hemorrhage, 62 cases showed significant improvement, 78 cases were effective, and 22 cases were ineffective. The two groups of patients were compared in terms of sex composition, age, body mass index, family history of hypertension, aneurysm diameter, aneurysm neck width, aneurysm location, time from onset to endovascular embolization, Hunt-Hess grade, and levels of vascular endothelial growth factor, nitric oxide synthase, and endothelin-1, and they were not different between the groups based on the χ2/ t test (P > 0.05). In the ineffective group, the proportions of patients with Fisher grades Ⅲ to Ⅳ on brain CT and relative mRNA expressions of NF-κB and serum miR-27a were higher than those in the effective group (P < 0.05). The multivariable Logistic regression analysis demonstrated that the Fisher grade on brain CT [O^R = 4.513 (95% CI: 1.801, 11.304)], NF-κB mRNA levels [O^R = 4.406 (95% CI: 1.759, 11.036) ], and serum miR-27a levels [O^R = 4.491 (95% CI: 1.793, 11.248) ] were factors affecting ineffective endovascular embolization therapy in patients with aneurysmal subarachnoid hemorrhage (P < 0.05). The receiver operating characteristic (ROC) curve analysis showed that the sensitivities of serum miR-27a, NF-κB, and their combination in predicting the efficacy of endovascular embolization therapy in patients with aneurysmal subarachnoid hemorrhage were 0.679 (95% CI: 0.541, 0.759), 0.603 (95% CI: 0.529, 0.714), and 0.725 (95% CI: 0.641, 0.816), with the specificities being 0.771 (95% CI: 0.681, 0.863), 0.842 (95% CI: 0.752, 0.937), and 0.961 (95% CI: 0.814, 0.998), and the areas under the curves being 0.746 (95% CI: 0.631, 0.854), 0.735 (95% CI: 0.629, 0.851), 0.851 (95% CI: 0.772, 0.958), respectively.Conclusions The abnormal expressions of serum miR-27a and NF-κB are associated with the therapeutic response of patients with aneurysmal subarachnoid hemorrhage to endovascular embolization. The combined detection of serum miR-27a and NF-κB can enhance the predictive value for the therapeutic efficacy of endovascular embolization in patients with aneurysmal subarachnoid hemorrhage.