目的

分析血清微小核糖核酸-130a（miR-130a）的表达、入院时格拉斯哥昏迷量表（GCS）评分对老年高血压脑出血患者脑血肿扩大的预测价值。

方法

选取2019年3月至2021年9月中国人民解放军联勤保障部队第966医院收治的208例老年高血压脑出血患者为疾病组，根据是否发生脑血肿扩大将疾病组分为脑血肿扩大组和脑血肿未扩大组，入院时采用GCS评估患者的昏迷程度。另选择同期本院健康体检的180例老年人为对照组。收集3组患者的一般临床资料并采用实时荧光定量聚合酶链式反应检测所有患者血清miR-130a的表达。采用方差分析或χ²检验比较3组间一般临床资料、GCS评分和miR-130a表达的差异，采用Logistic多元回归分析明确疾病组脑血肿扩大的影响因素，绘制受试者操作特征（ROC）曲线分析其对脑血肿扩大的预测价值。

结果

脑血肿扩大组患者35例（16.83%，35/208），脑血肿未扩大组患者173例（83.17%，173/208）。脑血肿扩大组、脑血肿未扩大组和对照组3组在入院时收缩压、入院时舒张压、是否患有高血压比较［（154.29±17.93）mmHg vs （152.34±20.93）mmHg vs（142.74±18.52）mmHg，（93.67±12.72）mmHg vs（92.80±10.74）mmHg vs（84.55±10.18）mmHg，22（62.85%）vs 98（56.65%）vs 63（35.00%）］，差异具有统计学意义，F=12.540，P＜0.001；F=29.930，P＜0.001；χ²=6.327，P＜0.001）。与脑血肿未扩大组比较，脑血肿扩大组GCS评分更低、血清miR-130a表达水平更高、血肿体积更大［（6.09±1.57）分 vs（7.84±1.63）分；（1.99±0.32）vs（1.50±0.28）；23.60（14.30，36.50）ml vs 15.50（4.60，20.80）ml］，差异具有统计学意义（P＜0.001、＜0.001、0.039）。Logistic多元回归分析显示，入院时GCS评分、血清miR-130a表达是疾病组发生脑血肿扩大的影响因素（OR=6.931、8.831，P均＜0.001）。血清miR-130a表达和入院时GCS评分对脑血肿扩大预测的ROC曲线下面积为0.931、0.772。

结论

老年高血压脑出血患者血清miR-130a高表达和入院时GCS评分低均可预测脑血肿扩大。

Objective

To analyze the predictive value of serum microribonucleic acid-130a（miR-130a） expression and admission Glasgow coma scale （GCS） score for the hematoma enlargement elderly patients with hypertensive intracerebral hemorrhage （ICH）.

Methods

A total of 208 elderly patients with hypertensive ICH admitted to the 966th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from March 2019 to September 2021 were enrolled as the disease group. This group was divided into an enlarged hematoma subgroup （35 cases） and an unexpanded hematoma subgroup（173 cases） based on the occurrence of hematoma enlargement. Additionally, 180 healthy elderly individuals who underwent routine health examinations at our hospital during the same period were enrolled as the control group. Real-time fluorescence quantitative polymerase chain reaction （RT-qPCR） was used to detect serum miR-130a expression levels in all participants； Logistic regression analysis was used to identify the influencing factors of brain hematoma enlargement in the disease group, and the receiver operating characteristic （ROC） curve was drawn to analyze its diagnostic value for brain hematoma enlargement.

Results

Statistically significant differences were observed among the enlarged hematoma group, nonenlarged hematoma group, and control group in terms of systolic blood pressure （SBP） at admission,diastolic blood pressure （DBP） at admission, and the prevalence of hypertension ［（154.29±17.93） mmHg vs （152.34±20.93） mmHg vs （142.74±18.52） mmHg, F=12.540, P＜0.001； （93.67±12.72） mmHg vs（92.80±10.74） mmHg vs （84.55±10.18） mmHg, F=29.930, P＜0.001； 22 （62.85%） vs 98 （56.65%） vs 63 （35.00%）, χ²=6.327, P＜0.001］. Significant differences were also noted between the enlarged and nonenlarged hematoma groups in GCS score, serum miR-130a expression, and hematoma volume ［（6.09±1.57）vs （7.84±1.63）, （1.99±0.32） vs （1.50±0.28）, and 23.60 （14.30, 36.50） ml vs 15.50 （4.60, 20.80） ml, all P＜0.05］. The incidence of hematoma enlargement in the disease group was 16.83% （35/208）. Logistic regression analysis revealed that admission GCS score and serum miR-130a expression were significant predictors of hematoma enlargement （OR=6.931 and 8.831, respectively； both P＜0.001）. ROC curve analysis showed that serum miR-130a and admission GCS score had AUC values of 0.931 and 0.772, respectively,for predicting hematoma enlargement.

Conclusion

Both elevated serum miR-130a and admission GCS score are valuable predictors of hematoma enlargement in elderly patients with hypertensive ICH.