Changes of serum miR-21-5p level in patients with acute spinal cord injury treated with ganglioside and methylprednisolone pulse therapy and its correlation with therapeutic effect

Abstract

Background: Acute spinal cord injury (ASCI) is a serious central nervous system condition that carries a high rate of disability and mortality, making it a primary focus of clinical research. The commonly used drugs for ASCI are ganglioside (GM-1) and methylprednisolone (MP). There are few studies available on the impact of GM-1 combined with MP pulse therapy on the clinical outcomes of patients with ASCI and the underlying mechanisms involved.

Methods: In a randomized controlled trial, the 100 patients with ASCI who were treated at our hospital from 2021 to 2024 were selected for this study. They were arbitrarily separated into two equal cohorts, a control cohort and an observation cohort, each containing 50 patients. While the control cohort underwent treatment solely with GM-1, the observation cohort additionally received MP pulse therapy, both treatments administered over a span of six months. The general information of patients was recorded. The motor score, acupuncture pain score, light touch score, Barthel Index (BI) for evaluating daily living capabilities, American Spinal Injury Association (ASIA) neurological function score, and visual analogue scale (VAS) score were analyzed between the two groups before and after treatment to evaluate the recovery of neurological function. Additionally, quantitative real-time PCR (qRT-PCR) was used to assess the serum levels of miR-21-5p in both groups. Moreover, the concentrations of serum inflammatory markers, such as C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), along with nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF), were quantified using ELISA. The Pearson method was employed to evaluate the correlation between miR-21-5p and the levels of CRP, TNF-α, IL-6, NGF, and BDNF. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive ability of serum miR-21-5p regarding treatment effectiveness in patients with ASCI.

Results: Three patients dropped out of the control group, and no patient dropped out of the observation group. There were no significant variations in the baseline data, index scores, or factor levels between the two groups prior to treatment (P > 0.05). After undergoing therapy, the observation group exhibited significantly higher BI index, ASIA motor and sensory scores, as well as increased in serum miR-21-5p levels, BDNF, and NGF compared to the reference group (P < 0.05). Furthermore, the observation group exhibited marked decreases in VAS ratings as well as serum CRP, TNF-α, and IL-6 levels, in stark contrast to the control group (P < 0.05). Furthermore, the level of miR-21-5p exhibited a negative correlation with the levels of CRP, TNF-α, and IL-6 (P < 0.05), while showing a positive correlation with the levels of BDNF and NGF (P < 0.05). The ROC curve analysis indicated that miR-21-5p possesses strong diagnostic potential for assessing ASCI efficacy, with an area under the curve (AUC) of 0.987, a sensitivity rate of 91.49%, and a specificity rate of 100.00%.

Conclusions: The combination of GM-1 and MP pulse therapy can significantly enhance neurological symptoms and facilitate the restoration of neurological function in patients with ASCI. This effect may be ascribed to the increased levels of miR-21-5p, BDNF, and NGF, along with a reduction in serum inflammatory factors.