血清HSP47、miR-181c水平与自发性脑出血患者神经损伤及微创术后预后的关系OA

Objective To investigate the relationship between serum heat shock protein 47(HSP47)and microRNA-181c(miR-181c)levels with neurological injury and prognosis after minimally invasive surgery in the patients with spontaneous intracerebral hemorrhage(sICH).Methods A total of 237 sICH patients ad-mitted and treated in Bengbu Municipal Hospital of Traditional Chinese Medicine from May 2023 to October 2024 were selected as the study subjects.The neurological injury degree of the patients within 24 h after ad-mission was assessed by using the National Institutes of Health Stroke Scale(NIHSS).All patients with sICH underwent the minimally invasive hematoma evacuation within 72 h after admission and were postopera-tively followed up for 3 months.They were divided into the poor prognosis group and good prognosis group based on their prognosis.The baseline data,serum HSP47 and miR-181c levels were compared between the two groups.The serum HSP47 and miR-181c levels were also compared among the patients with different de-grees of neurological injury.The correlation between serum HSP47 and miR-181c levels with the neurological injury severity degree in sICH patients was analyzed.The multivariate Logistic regression was used to analyze the influencing factors for poor postoperative prognosis in sICH patients.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive efficiency of serum HSP47 and miR-181c for poor postoper-ative prognosis.The restricted cubic spline(RCS)was adopted to analyze the dose-response relationship be-tween serum HSP47 and miR-181c levels with poor postoperative prognosis.Results In postoperative 3 months,the incidence rate of poor prognosis after minimally invasive surgery in sICH patients was 33.05%,there were 78 cases in the poor prognosis group and 158 cases in the good prognosis group.The age,systolic blood pressure,fasting blood glucose(FBG),hematoma volume,edema volume around the hematoma and neurological deficit severity had the statistically significant differences between the two groups(all P<0.05).Serum HSP47 and miR-181c levels in the poor prognosis group were higher than those in the good prognosis group(P<0.05).The serum HSP47 and miR-181c levels in the severe sICH patients were higher than those in mild,moderate and moderate to severe injury(P<0.05);the serum HSP47 and miR-181c levels in the pa-tients with moderate to severe injury were higher than those in mild or moderate injury(P<0.05);the serum HSP47 and miR-181c levels in the patients with moderate injury were higher than those with mild injury(P<0.05).Serum HSP47 and miR-181c levels in sICH patients were positively correlated with the neurological in-jury degree(rs=0.498,0.415;both P<0.05).The increased systolic blood pressure,increased FBG level,neurological deficit severity aggravation,hematoma volume enlargement,perihematomal edema volume en-largement,increased HSP47 level and increased miR-181c level all were the independent risk factors for poor postoperative prognosis in sICH patients(P<0.05).The areas under the curves(AUCs)of serum HSP47 and miR-181c alone and their combination in predicting the poor postoperative prognosis in sICH patients were 0.745,0.755 and 0.850,respectively.The AUC of the 2-item combination was significantly higher than that of HSP47 and miR-181c alone(Z=2.519,2.158;both P<0.05).The RCS analysis revealed the non-lin-ear relationship between HSP47 and miR-181c with poor postoperative prognosis in sICH patients(P<0.05).When HSP47≥396.85 ng/L,the risk of poor postoperative prognosis in sICH patients was signifi-cantly increased with the HSP47 level increase.For the patients with miR-181c<1.47,the risk of poor postop-erative prognosis in sICH patients was decreased with the miR-181c level increase;while when miR-181c≥1.47,the risk of poor postoperative prognosis in sICH patients was significantly increased with the miR-181c level increase.Conclusion Serum HSP47 and miR-181c are closely correlated with the neurological injury se-verity degree and prognosis after minimally invasive surgery in sICH patients.The 2-item combination detection could significantly increase the predictive efficiency for the poor postoperative prognosis in sICH patients.