脑梗死预后相关生物标志物的研究新进展：机制与临床应用

doi:10.12114/j.issn.1007-9572.2024.0332

中国全科医学 ›› 2025, Vol. 28 ›› Issue (29): 3711-3720.DOI: 10.12114/j.issn.1007-9572.2024.0332

脑梗死预后相关生物标志物的研究新进展：机制与临床应用

农景堂¹^,²^,³, 杨成敏², 莫圣龙², 陆志成¹^,², 唐丽娜¹^,², 简崇东²^,⁴^,^*(), 商敬伟²^,⁴^,^*()

1．533000　广西壮族自治区百色市，右江民族医学院研究生学院
2．533000　广西壮族自治区百色市，右江民族医学院附属医院神经内科
3．530000　广西壮族自治区南宁市，广西壮族自治区民族医院
4．533000　广西壮族自治区百色市代谢性疾病重点实验室

收稿日期:2024-09-10 修回日期:2024-11-20 出版日期:2025-10-15 发布日期:2025-07-15
通讯作者: 简崇东, 商敬伟
农景堂和杨成敏为共同第一作者

作者贡献：
农景堂开展研究，撰写并修改文章；莫圣龙、陆志成、唐丽娜进行文献检索与筛选；杨成敏提取与分析数据；简崇东提出研究思路，指导研究的开展；商敬伟提供技术和资料支持，修改文章。
基金资助:
国家自然科学基金资助项目(81860244，82160254); 百色市科学研究与技术开发计划课题(百科20224117)

Research Progress on Prognostic Biomarkers after Cerebral Infarction: Mechanisms and Clinical Applications

NONG Jingtang¹^,²^,³, YANG Chengmin², MO Shenglong², LU Zhicheng¹^,², TANG Lina¹^,², JIAN Chongdong²^,⁴^,^*(), SHANG Jingwei²^,⁴^,^*()

1. Graduate School of Youjiang Medical College for Nationalities, Baise 533000, China
2. Department of Neurology, Affiliated Hospital of Youjiang Medical College for Nationalities, Baise 533000, China
3. Guangxi Zhuang Autonomous Region Ethnic Hospital, Nanning 530000, China
4. Key Laboratory of Metabolic Diseases in Baise City, Baise 533000, China

Received:2024-09-10 Revised:2024-11-20 Published:2025-10-15 Online:2025-07-15
Contact: JIAN Chongdong, SHANG Jingwei
About author:
NONG Jingtang and YANG Chengmin are co-first authors

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摘要/Abstract

摘要： 缺血性卒中（又称脑梗死）作为导致全球残疾和死亡的主要原因之一，近年来，其预后生物标志物的研究取得了显著进展。本文综述了包括血细胞分析指标（如红细胞体积分布宽度）、ω-3多不饱和脂肪酸、细胞因子（如白介素6、肿瘤坏死因子α）、微小核糖核酸（miRNA，如miR-21、miR-155、miR-126）和外泌体在内的多种生物标志物在缺血性脑卒中中的作用机制及其在预后评估中的研究进展。综述得出，血细胞分析相关指标、ω-3多不饱和脂肪酸、白介素6、肿瘤坏死因子α的浓度与缺血性脑卒中的严重程度和预后密切相关。其中，较高基线红细胞体积分布宽度与复发性缺血性脑卒中的风险增加相关，并且与缺血性脑卒中的复发时间呈负相关。特定miRNA（如miR-21）通过抑制细胞凋亡和促进神经元存活，改善神经功能恢复；而miR-155通过调控炎症反应加剧脑损伤，其表达水平可预测缺血性脑卒中的复发；此外，miR-126在血管生成和神经保护中发挥关键作用。外泌体则通过携带抗炎因子、神经营养因子、抗氧化酶和热休克蛋白等，显著减轻缺血再灌注引起的炎症和损伤，从而影响缺血性脑卒中的预后。尽管这些生物标志物在缺血性脑卒中预后评估中显示出巨大潜力，但其临床应用仍面临诸多挑战，包括个体间差异、长期效应和安全性研究不足以及技术标准化问题。未来研究应进一步探讨这些标志物的作用机制，开发标准化的检测方法，并进行大规模临床验证，以便将其应用于临床，改善缺血性脑卒中患者的预后和生活质量。

关键词: 脑梗死, 预后, 生物标志物, 细胞因子, 微小核糖核酸, 外泌体, 综述

Abstract:

Ischemic stroke (IS) is one of the leading causes of disability and death worldwide. Various biomarkers closely associated with IS prognosis have been identified in recent years. This paper reviewed the mechanisms of action of blood cell analysis related indicators, omega-3 polyunsaturated fatty acids, IL-6, TNF-α, miRNA, and extracellular vesicles in ischemic stroke and their research progress as predictive biomarkers. The concentrations of blood cell analysis related indicators, omega-3 polyunsaturated fatty acids, IL-6 and TNF-α were closely related to the severity and prognosis of IS. Among them, a higher baseline red blood cell volume distribution width was associated with an increased risk of recurrent ischemic stroke, and was negatively correlated with the recurrence time of ischemic stroke. miR-21 improved neuronal functional recovery by inhibiting apoptosis and promoting neuronal survival, while miR-155 exacerbated brain injury by regulating inflammatory responses, with its expression level predicting IS recurrence. Moreover, miR-126 played a crucial role in angiogenesis and neuroprotection. Extracellular vesicles, carrying anti-inflammatory factors, neurotrophic factors, antioxidant enzymes, and heat shock proteins, mitigate inflammation and damage caused by ischemia-reperfusion, significantly influencing IS prognosis. Despite the tremendous potential of these biomarkers in IS prognosis assessment, their clinical application faced several challenges, including interindividual differences, inadequate research on long-term effects and safety, and issues with technical standardization. Future research should focus on elucidating the mechanisms of action of these biomarkers, developing standardized detection methods, and conducting large-scale clinical validation, to apply them in clinical practice to improve the prognosis and quality of life of IS patients.

Key words: Brain infarction, Prognosis, Biomarkers, Cytokines, MicroRNAs, Extracellular vesicles, Review

中图分类号:

R 743.33

农景堂,杨成敏,莫圣龙,等. 脑梗死预后相关生物标志物的研究新进展：机制与临床应用[J]. 中国全科医学, 2025, 28(29): 3711-3720. DOI: 10.12114/j.issn.1007-9572.2024.0332.
NONG Jingtang,YANG Chengmin,MO Shenglong, et al. Research Progress on Prognostic Biomarkers after Cerebral Infarction: Mechanisms and Clinical Applications[J]. Chinese General Practice, 2025, 28(29): 3711-3720. DOI: 10.12114/j.issn.1007-9572.2024.0332.

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脑梗死预后相关生物标志物的研究新进展：机制与临床应用

Research Progress on Prognostic Biomarkers after Cerebral Infarction: Mechanisms and Clinical Applications

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