血清miRNA-133a和miR-21在老年脊柱骨折伴脊髓损伤患者中的表达及其与预后的相关性^*

Serum miRNA-133a and miR-21 expression and their correlation with prognosis in elderly patients with spinal fracture complicated by spinal cord injury

摘要

目的 探究血清miRNA-133a和miR-21在老年脊柱骨折伴脊髓损伤患者中的表达及其与预后的相关性。方法 选取2021年6月—2024年6月中国人民解放军联勤保障部队第九○四医院纳入的96例老年脊柱骨折伴脊髓损伤患者为脊髓损伤组,根据预后情况分为预后良好组(67例)和预后不良组(29例)。另选取50例同期单纯老年脊柱骨折患者作为对照组。比较血清miRNA-133a和miR-21在不同组别中的表达情况,采用多因素logistic回归模型分析老年脊柱骨折伴脊髓损伤患者预后的影响因素并构建列线图,采用Bootstrap法进行内部验证,并通过绘制校准曲线及Hosmer-Lemeshow检验评估一致性。构建ROC曲线分析血清miRNA-133a和miR-21对老年脊柱骨折伴脊髓损伤患者预后的预测价值,并采用DeLong检验比较两条ROC曲线下面积的差异。结果 脊髓损伤组的miRNA-133a表达水平低于对照组,miR-21表达水平高于对照组(P<0.05)。预后不良组的受伤至激素类药物使用时间、椎管侵占率≥50%患者占比、脊髓损伤程度为完全性患者占比以及miR-21表达水平均高于预后良好组(P<0.05),预后不良组miRNA-133a表达水平低于预后良好组(P<0.05)。多因素logistic回归模型结果显示,受伤至激素类药物使用时间、椎管侵占率≥50%、脊髓损伤程度为完全性、miR-21、miRNA-133a均是老年脊柱骨折伴脊髓损伤患者预后的影响因素(P＜0.05)。Bootstrap内部验证显示其区分度良好(C-index 为0.967,95%CI:0.930～0.999)。Hosmer-Lemeshow 检验显示差异无统计学意义(P>0.05)。ROC结果表明,血清miRNA-133a和miR-21对老年脊柱骨折伴脊髓损伤患者预后均有一定的预测价值,但miR-21比miRNA-133a的诊断效能更高(P＜0.05)。结论 血清miRNA-133a和miR-21对老年脊柱骨折伴脊髓损伤患者的预后有着良好的预测价值。

Abstract

Objective To investigate the expression of serum miRNA-133a and miR-21 in elderly patients with spinal fracture complicated by spinal cord injury and analyze their correlation with prognosis. Methods A total of 96 elderly patients with spinal fracture complicated by spinal cord injury admitted to the 904th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from June 2021 to June 2024 were enrolled in the spinal cord injury group. According to prognosis, they were divided into the good prognosis group (67 cases) and the poor prognosis group (29 cases). In addition, 50 elderly patients with simple spinal fracture admitted during the same period were selected as the control group. The expression levels of serum miRNA-133a and miR-21 were compared among the different groups. Multivariate logistic regression analysis was performed to identify the prognostic factors in elderly patients with spinal fracture combined with spinal cord injury and to construct a nomogram. Bootstrap resampling was employed for internal validation of the nomogram, and its consistency was assessed by plotting calibration curves and performing the Hosmer-Lemeshow test. ROC curves were plotted to evaluate the predictive value of serum miRNA-133a and miR-21 for prognosis, and the DeLong test was used to compare the differences in the ROC area under the curves. Results The serum miRNA-133a level in the spinal cord injury group was significantly lower than that in the control group, while the miR-21 level was significantly higher (P<0.05). The poor prognosis group had a longer time from injury to corticosteroid administration, a higher proportion of spinal canal occupancy ≥50%, a higher proportion of complete spinal cord injury, and higher miR-21 levels, but lower miRNA-133a levels than the good prognosis group (P<0.05). Multivariate logistic regression analysis demonstrated that time from injury to corticosteroid administration, spinal canal occupancy rate, degree of spinal cord injury, miR-21, and miRNA-133a were independent factors influencing prognosis in elderly patients with spinal fracture complicated by spinal cord injury (P<0.05). Internal validation using the Bootstrap method showed that the model had good discriminative ability(C-index=0.967,95%CI=0.930-0.999). The Hosmer-Lemeshow test showed no statistically significant difference (P>0.05). ROC results showed that both serum miRNA-133a and miR-21 had certain predictive value for the prognosis of elderly patients with spinal fracture combined with spinal cord injury; however, miR-21 demonstrated higher diagnostic efficacy than miRNA-133a (P <0.05). Conclusion Serum miRNA-133a and miR-21 have good predictive value for the prognosis of elderly patients with spinal fracture complicated by spinal cord injury.

关键词

脊柱骨折 / 脊髓损伤 / miRNA-133a / miR-21 / 预后

Key words

Spinal fracture / Spinal cord injury / MiRNA-133a / MiR-21 / Prognosis

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基金资助

^*江苏省科技计划项目基础研究计划自然科学基金青年基金资助项目(BK20230453)