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目的 分析急性脑梗死患者血清外泌体差异基因表达谱,以期阐明脑梗死损伤相关的基因表达变化和潜在血清标志物.方法 第Ⅰ期研究纳入4例急性脑梗死患者和5例健康人,外周血分离血清后用外泌体试剂盒提取外泌体,运用基因芯片技术检测mRNA表达谱,筛选有差异表达的mRNAs,同时对其进行GO功能及KEGG通路富集分析.进一步运用实时聚合酶链式反应(qRT-PCR)在第Ⅱ期收集的32例急性脑梗死病例组患者和32例正常对照组患者血清外泌体中验证所筛选的差异mRNA的表达水平.结果 第Ⅰ期研究中5例正常对照组患者与4例病例组患者之间共有248个差异表达的mRNA(差异倍数≥2.0,P<0.05),其中242个mRNA表达上调,6个mRNA表达下调.GO功能富集分析结果主要为行为调节、细胞连接及抗氧化活性等,KEGG通路富集分析结果主要为核糖体、蛋白酶体、催产素信号通路及氧化磷酸化等.差异表达显著的基因中,经过相关文献调研、筛选,发现H3F3B mRNA异常表达可能在急性脑梗死发生过程中起到重要作用,随后采用qRT-PCR法检测第Ⅱ期所收集的32例正常组患者与32例病例组患者血清外泌体中H3F3B mRNA表达量,与正常组相比,病例组患者血清外泌体中,H3F3B mRNA表达量明显升高(P<0.001);病例组血清外泌体中H3F3B mRNA表达量分别与年龄、美国国立卫生研究院卒中量表(NIHSS)评分、最大梗死灶面积呈正相关(P<0.05).结论 急性脑梗死可导致血清外泌体mRNA表达谱改变,其与急性脑梗死的发生、发展及预后可能密切相关,这些发现将为研究急性脑梗死的分子机制、诊断标志物及治疗靶点提供方向.“,”Objective To analyze the differential gene expression profile of serum exosomes in patients with acute cerebral infarction (ACI) and clarify the changes in gene expression related to cerebral in-farction injury and the potential serum markers.Methods Four patients with ACI and five healthy people were en-rolled in the Phase Ⅰ study. After serum isolation from peripheral blood, exosomes were extracted with exosomes kits, high-throughput detection of mRNA was performed with gene chips, and differentially expressed mRNAs were screened. Gene Onto-logy (GO) functional analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were per-formed simultaneously. Furthermore, real-time polymerase chain reaction (qRT-PCR) was used to verify the expression levels of the screened differential mRNAs in the serum exosomes collec-ted in Phase Ⅱ from 32 patients each in the ACI case and normal control groups. Results In the Phase Ⅰ study, there were 248 differentially ex-pressed mRNAs (fold change ≥ 2.0, P < 0.05) among five pa-tients in the normal control group and four patients in the case group, of which the expression of 242 was upregulated and that of six was downregulated. The results of GO functional enrichment analysis mainly included behavior regulation, cell connection, and antioxidant activity. The results of KEGG pathway enrich-ment analysis mainly included ribosomes, proteasomes, oxyto-cin signaling pathways, and oxidative phosphorylation. After re-searching and screening based on relevant literature, it was found that among the genes with significant differential expression, H3F3B mRNA may be associated with and might play an important role in ACI. The qRT-PCR method was used to detect the H3F3B mRNA expression in serum exosomes of 32 patients each in the normal control and case groups in Phase Ⅱ; the expression was significantly higher in serum exosomes of the case group than in those of the normal control group (P < 0.001). H3F3B mRNA expression in serum exosomes of the case group positively correlated with age, the National Institutes of Health Stroke Scale (NIHSS) score, and the maximum infarct size (P <0.05).Conclusion ACI can lead to changes in the serum exosomes mRNA expression profile, which may be closely related to the oc-currence, development, and prognosis of this condition. These findings will provide direction for research on the molecular mechanism, diagnostic markers, and therapeutic targets of ACI.