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目的:探讨老年急性缺血性脑卒中（AIS）患者血清微小RNA-24（miR-24）和微小RNA-29b（miR-29b）表达水平及其对神经功能预后的预测价值。方法:采用前瞻性研究方法，选择2017年1月1日至2019年3月31日儋州市人民医院神经内科收治的170例老年AIS患者。根据改良Rankin量表（mRS）评分将患者分为神经功能预后良好组（mRS评分≤2分，105例）和预后不良组（mRS评分>2分，65例）；根据美国国立卫生研究院卒中量表（NIHSS）评分将患者分为轻度组（NIHSS评分20分，44例）。选择同期本院65例体检正常者作为健康对照组。采用实时荧光定量反转录-聚合酶链反应（RT-qPCR）检测血清miR-24、miR-29b表达水平。绘制受试者工作特征曲线（ROC），分析血清miR-24、miR-29b表达水平对老年AIS患者神经功能预后不良的预测价值；采用Pearson相关法分析老年AIS患者血清miR-24、miR-29b表达水平与NIHSS、mRS评分的相关性。结果:AIS组患者血清miR-24、miR-29b表达均明显低于健康对照组〔miR-24（2n -ΔΔCt）：0.64±0.17比2.18±0.85，miR-29b（2n -ΔΔCt）：0.72±0.21比3.05±0.96，均n P<0.01〕。预后不良组患者血清miR-24、miR-29b表达均明显低于预后良好组〔miR-24（2n -ΔΔCt）：0.20±0.05比1.16±0.48，miR-29b（2n -ΔΔCt）：0.18±0.03比1.41±0.56，均n P<0.01〕。重度组患者血清miR-24、miR-29b表达明显低于轻度组和中度组〔miR-24（2n -ΔΔCt）：0.13±0.02比1.30±0.51、0.56±0.14，miR-29b（2n -ΔΔCt）：0.09±0.01比1.52±0.60、0.62±0.13，均n P<0.01〕，且中度组表达水平明显低于轻度组（均n P<0.01）。ROC曲线分析显示，血清miR-24、miR-29b表达水平预测老年AIS患者神经功能预后不良的最佳截断值分别为0.53、0.48，二者联合预测的ROC曲线下面积（AUC）为0.920〔95%可信区间（95%n CI）为0.861～0.982〕，明显大于miR-24（AUC为0.802，95%n CI为0.742～0.860）或者miR-29b（AUC为0.835，95%n CI为0.778～0.890）单独预测（n Z值分别为6.513、4.902，均n P<0.05），其敏感度、特异度分别为92.0%和85.7%。Pearson相关分析显示，老年AIS患者血清miR-24、miR-29b表达水平与NIHSS评分（n r值分别为-0.758、-0.794）、mRS评分（n r值分别为-0.817、-0.860）均呈显著负相关（均n P 2, n n = 65). According to National Institutes of Health stroke scale (NIHSS) score, the patients were divided into mild group (NIHSS score 20, n n = 44). Sixty-five healthy volunteers in the same period were enrolled as the control group. The expressions of serum miR-24 and miR-29b were determined by real-time fluorescent quantitative reverse transcription-polymerase chain reaction (RT-qPCR). Receiver operating characteristic (ROC) curve was plotted to analyze the value of serum expressions of miR-24 and miR-29b for predicting the poor neural function prognosis of elderly patients with AIS. Pearson correlation was used to analyze the correlation between the expressions of serum miR-24, miR-29b and NIHSS, mRS scores in elderly patients with AIS.n Results:The expressions of serum miR-24 and miR-29b in the AIS group were significantly lower than those in the healthy control group [miR-24 (2n -ΔΔCt): 0.64±0.17 vs. 2.18±0.85, miR-29b (2n -ΔΔCt): 0.72±0.21 vs. 3.05±0.96, both n P < 0.01]. The expressions of serum miR-24 and miR-29b in the poor neural function prognosis group were significantly lower than those in the good neural function prognosis group [miR-24 (2 n -ΔΔCt): 0.20±0.05 vs. 1.16±0.48, miR-29b (2n -ΔΔCt): 0.18±0.03 vs. 1.41±0.56, both n P < 0.01]. The expressions of serum miR-24 and miR-29b in the severe group were significantly lower than those in the mild and moderate groups [miR-24 (2 n -ΔΔCt): 0.13±0.02 vs. 1.30±0.51, 0.56±0.14; miR-29b (2n -ΔΔCt): 0.09±0.01 vs. 1.52±0.60, 0.62±0.13; all n P < 0.01], and they were significantly lower in the moderate group than those in the mild group (all n P < 0.01). ROC curve analysis showed that the optimal cut-off values of serum miR-24 and miR-29b expressions for predicting poor neural function prognosis in elderly AIS patients were 0.53 and 0.48, respectively. The area under ROC curve (AUC) of the two combined prognoses was 0.920 [95% confidence interval (95% n CI) was 0.861-0.982], and it was significantly higher than that of miR-24 (AUC was 0.802, 95%n CI was 0.742-0.860) or miR-29b (AUC was 0.835, 95%n CI was 0.778-0.890) alone (n Z values were 6.513 and 4.902, respectively, both n P < 0.05), with sensitivity and specificity of 92.0% and 85.7%. Pearson correlation analysis showed that the expressions of serum miR-24 and miR-29b were negatively correlated with NIHSS score ( n r values were -0.758 and -0.794, respectively) and mRS score (n r values were -0.817 and -0.860, respectively) in elderly AIS patients (all n P < 0.01).n Conclusion:The down-regulated expressions of serum miR-24 and miR-29b are correlated with the severity degree of neurological impairment and neural function prognosis of elderly AIS patients, and the two combined have certain value for predicting the neural function prognosis of elderly AIS patients.