Abstract: Objective To investigate the relationship between serum miR-29b,Aquaporin-4 (AQP4) and disease progression,white matter hyperintensities (WMH) in elderly patients with acute lacunar infarction (ALI).Methods 128 elderly patients with ALI who were hospitalized in the department of Neurology of our hospital from January 2018 to December 2018 were selected as the research group,and 60 subjects with matched age and gender and without any cerebral infarction were selected as the control group.The expression of serum miR-29b was measured by real-time fluorescence quantitative PCR,and the level of serum AQP4 was measured by enzyme-linked immunosorbent assay.Early neurological dysfunction (END) was evaluated according to NIHSS scores on admission and after 7 days; the WMH volume was determined according to the Results of brain MRI scan within 7 days after admission; and the progress of cerebral microbleeds was judged by brain MRI after 1-year follow-up.Results Compared with the control group,the expression of miR-29b in the study group was lower,while the serum AQP4 level was increased (P<0.05),and there was a negative correlation between the serum miR-29b and AQP4 level in ALI patients (r=-0.791,P<0.001).The area under ROC curve of serum miR-29b for the diagnosis of ALI was 0.881 (95%CI:0.798~0.934),which was more than the AUC of serum AQP4 (P<0.05).In addition,compared with the non-END subgroup (n=96),the serum miR-29b expression was decreased and the serum AQP4 level was increased in the END subgroup (n=32) (P<0.05).Compared with WMH mild lesion subgroup(n=50),the serum miR-29b expression was decreased and serum AQP4 level was increased in severe lesion subgroup (n=78) (P<0.05).Compared with the no cerebral microbleeds progressive subgroup (n=104),the serum miR-29b expression was decreased and the serum AQP4 level was increased in the progressive subgroup (n=24) (P<0.05).Conclusion The serum miR-29b expression is decreased,while serum AQP4 protein level is increased in elderly ALI patients,which would be related to the occurrence of END,the degree of WMH lesions and the progress of cerebral microbleeds in one year follow-up.Serum miR-29b would be a potential biomarker for early diagnosis of ALI.

Key words: Acute lacunar infarction, Elderly patients, MiR-29b/AQP4, Disease progression, White matter hyperintensities

摘要： 目的 为了探讨老年急性腔隙性脑梗死(ALI)患者血清miR-29b和水通道蛋白4(AQP4)水平与病情进展和脑白质病变的相关性。方法 选取2018年1月~2018年12月期间在我院神经内科住院的128例老年ALI患者作为研究组,另外选择年龄和性别匹配的60例非脑梗死人群组成对照组;采用实时荧光定量PCR法测定2组血清miR-29b表达水平;采用酶联免疫吸附法测定2组血清中AQP4水平。根据入院和7d NIHSS评分判断早期神经功能障碍(END);根据入院7 d内脑部MRI扫描结果,判断脑白质病变(WMH)面积;随访1年复查脑部MRI,判断脑微出血进展。结果 与对照组相比,研究组ALI患者血清miR-29b表达降低,同时血清AQP4水平升高(P＜0.05),且ALI患者血清miR-29b与血清AQP4水平呈负相关性(r=-0.791,P＜0.001)。绘制ROC曲线,血清miR-29b诊断ALI的曲线下面积为0.881(95%CI:0.798~0.934),其诊断效能高于血清AQP4(P＜0.05)。此外,与非END亚组(n=96)相比,END亚组(n=32)ALI患者血清miR-29b表达降低,同时血清AQP4水平升高(P＜0.05)。与WMH轻度病变亚组(n=50)相比,重度病变亚组(n=78)患者血清miR-29b表达降低,同时血清AQP4水平升高(P＜0.05)。与无脑微出血进展亚组(n=104)相比,进展亚组(n=24)患者血清miR-29b表达降低,同时血清AQP4水平升高(P＜0.05)。结论 老年ALI患者血清miR-29b表达降低,同时AQP4蛋白水平增加,这与END的发生、WMH病变程度以及随访1年脑微出血进展有关,检测血清miR-29b有望成为ALI早期诊断的生物标志分子。

关键词: 急性腔隙性脑梗死, 老年患者, miR-29b/AQP4, 疾病进展, 脑白质病变