Relationship Between Serum miR-15b,miR-146a-5p Expression Levels and Short-Term Prognosis of Elderly Patients with Acute Cerebral Infarction and Its Predictive Value

WU Guang; YANG Feng; QIAO Xu; PENG Zhaolong

doi:10.3969/j.issn.1004-437X.2026.12.014

Abstract：Objective To investigate the relationship between the expression of serum microRNA-15b(miR-15b)and microRNA-146a-5p(miR-146a-5p)and the short-term prognosis of elderly patients with acute cerebral infarction(ACI)and its predictive value.Methods A total of 408 elderly patients with ACI admitted to Nanyang Nanshi Hospital from May 2022 to February 2025 were selected as the study subjects.The baseline data,laboratory indicators at admission and National Institutes of Health stroke scale(NIHSS)scores of the patients were collected,and the expression of serum miR-15b and miR-146a-5p was detected by reverse transcription-polymerase chain reaction(RT-PCR).The modified Rankin scale(mRS)score at 3 months after onset was used as the prognostic endpoint.Patients with mRS ≤ 2 were classified into the good prognosis group,and those with mRS＞2 were classified into the poor prognosis group.Logistic regression was used to analyze the relationship between the expression of serum miR-15b and miR-146a-5p and the short-term prognosis of elderly ACI patients.A nomogram was constructed to predict the short-term prognosis of elderly ACI patients.The receiver operating characteristic(ROC)curve was used to evaluate the discrimination,the Hosmer-Lemeshow goodness of fit test was used to assess the calibration ability,the decision curve was used to evaluate the clinical practical application value,and the consistency between the actual outcome and the predicted results was further evaluated by external validation.Results The poor prognosis rate of elderly ACI patients at 3 months after onset was 39.36％.The NIHSS score at admission and the proportion of infarct size ≥5 cm2 in the poor prognosis group were(9.74±2.34)and 35.22％,respectively,which were higher than those in the good prognosis group[(7.18±1.69)and 20.82％];the albumin(Alb)level was(38.42±5.69)g·L-1,which was lower than that in the good prognosis group[(42.11±6.75)g·L-1],and the differences were statistically significant(P＜0.05).The serum miR-15b expression level in the poor prognosis group was 2.32±0.51,which was higher than that in the good prognosis group(1.74±0.46);the serum miR-146a-5p expression level was 0.85±0.32,which was lower than that in the good prognosis group(1.42±0.43),and the differences were statistically significant(P＜0.05).Logistic regression analysis showed that NIHSS score at admission,infarct size and miR-15b were risk factors for poor short-term prognosis in elderly ACI patients,and miR-146a-5p was a protective factor(P＜0.05).The area under the curve(AUC)of the model was 0.898(95％CI:0.866-0.930).The Hosmer-Lemeshow test showed that the predicted probability of the model was in good agreement with the actual observation results(x2=6.895,P=0.536).The decision curve showed that the model could provide significant clinical net benefit within the threshold probability range of 0.01-0.80.In the external validation,the overall coincidence rate between the model prediction and clinical practice was as high as 92.96％,and the sensitivity,specificity and Kappa value were all higher than 0.85.Conclusion Serum miR-15b and miR-146a-5p are influencing factors for the short-term prognosis of elderly ACI patients.The nomogram constructed based on these factors has good discrimination,calibration and clinical practical value,and external validation confirms that the predicted results are highly consistent with the actual clinical outcomes.