目的：探讨湿性年龄相关性黄斑变性(ARMD)出血患者血清长链非编码RNA母系表达基因3(lncRNA MEG3)和微小RNA-138(miR-138)表达水平及其与患者预后的关系。

方法：前瞻性研究。选取2018-01/2021-06收治的湿性ARMD出血患者90例为观察组，选择同期在我院进行健康体检人员78名作为对照组。采用实时荧光定量PCR法(qRT-PCR)检测所有受试者血清lncRNA MEG3、miR-138表达水平。观察组患者注射雷珠单抗进行治疗，每月1次，共3次。治疗后随访3mo，根据预后情况分为预后良好组和预后不良组，比较两组患者lncRNA MEG3、miR-138水平。Pearson相关性分析lncRNA MEG3与miR-138的相关关系。采用受试者工作特征曲线(ROC)分析湿性ARMD出血患者预后不良的判断价值。多因素Logistic回归分析湿性ARMD出血患者预后不良的影响因素。

结果：与对照组相比，观察组患者血清lncRNA MEG3水平下降(1.13±0.37 vs 0.71±0.21)，miR-138水平上升(1.05±0.29 vs 2.23±0.54)(均P<0.05)。湿性ARMD出血患者预后良好组患者血清lncRNA MEG3水平明显高于预后不良组(0.81±0.24 vs 0.49±0.14)，而miR-138水平明显低于预后不良组(1.92±0.49 vs 2.87±0.63)(均P<0.05)。Pearson相关性分析结果显示，lncRNA MEG3与miR-138呈负相关(r=-0.381，P<0.05)。ROC曲线结果显示，血清lncRNA MEG3、miR-138表达水平对湿性ARMD出血患者发生预后不良AUC分别为0.859、0.828，截断值分别为0.635、2.455，敏感度分别为89.70%、75.90%，特异性分别为72.10%、82.00%。多因素Logistic回归分析显示lncRNA MEG3是湿性ARMD出血患者预后不良的保护因素，miR-138是危险因素(均P<0.05)。

结论：血清lncRNA MEG3、miR-138在湿性ARMD出血患者中表达异常，且对湿性ARMD出血患者的预后不良具有一定的评估价值。

METHODS: A prospective study. A total of 90 patients with wet ARMD hemorrhage admitted from January 2018 to June 2021 were selected as the observation group, and 78 people who underwent physical examination in our hospital during the same period were selected as the control group. Real-time fluorescent quantitative PCR(qRT-PCR)was used to detect the expression levels of serum lncRNA MEG3 and miR-138 in all subjects. Patients in the observation group were injected with Ranibizumab for treatment once a month, for a total of 3 times. The observation group was followed up for 3mo after treatment, and the patients were divided into good prognosis and poor prognosis group.The levels of lncRNA MEG3 and miR-138 were compared between the two groups. Pearson correlation was used to analyze the correlation between lncRNA MEG3 and miR-138. The receiver operating characteristic curve(ROC)was used to analyze the value of judging the poor prognosis of patients with wet ARMD hemorrhage. Multivariate Logistic regression was used to analyze the factors affecting the poor prognosis of patients with wet ARMD hemorrhage.

RESULTS: Compared with the control group, the level of serum lncRNA MEG3 in the observation group decreased(1.13±0.37 vs 0.71±0.21), and the miR-138 level increased(1.05±0.29 vs 2.23±0.54; all P<0.05). The level of serum lncRNA MEG3 of patients with wet ARMD hemorrhage in the good prognosis group was significantly higher than that in the poor prognosis group(0.81±0.24 vs 0.49±0.14), while the level of miR-138 was significantly lower than that in the poor prognosis group(1.92±0.49 vs 2.87±0.63; all P<0.05). Pearson correlation analysis results showed that lncRNA MEG3 was negatively correlated with miR-138(r=-0.381, P<0.05). The ROC curve results showed that the AUC of serum lncRNA MEG3 and miR-138 expression levels for the poor prognosis of patients with wet ARMD hemorrhage was 0.859 and 0.828, respectively, the cut-off value was 0.635 and 2.455, respectively, the sensitivity was 89.70% and 75.90%, respectively, and the specificity was 72.10% and 82.00%, respectively. Multivariate Logistic regression analysis showed that lncRNA MEG3 was a protective factor for poor prognosis of patients with wet ARMD hemorrhage, while miR-138 was a risk factor(all P<0.05).

CONCLUSION: Serum lncRNA MEG3 and miR-138 are abnormally expressed in patients with wet ARMD hemorrhage, and they have a certain value in evaluating the poor prognosis of patients with wet ARMD hemorrhage.