To analyze the relationship between Helicobacter pylori (H. pylori) infection and stress ulcers in elderly patients with primary brainstem hemorrhage (PBSH), and to explore the predictive value of serum tumor necrosis factor-α (TNF-α), matrix metalloproteinase-9 (MMP-9), miR-204, and miR-182 for secondary stress ulcers in elderly PBSH patients.

A retrospective analysis was conducted on the clinical data of elderly PBSH patients admitted to Neurosurgery Department of the First Affiliated Hospital of Anhui Medical University from June 2019 to March 2021. Based on the results of gastric occult blood (OB) in PBSH patients, they were divided into stress ulcer group and non stress ulcer group; According to the results of the patient's serum H. pylori urease antibody, they were divided into H. pylori positive group and H. pylori negative group. The levels of TNF-α and MMP-9 in serum were analyzed by dual antibody sandwich enzyme-linked immunosorbent assay; miR-204 and miR-182 levels were detected by fluorescence quantitative PCR; serum H. pylori urease antibody was detected by colloidal gold method, and gastric juice OB was detected by OB gold gel strip. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of TNF-α, MMP-9, miR-204 and miR-182 levels for secondary stress ulcers in elderly PBSH patients.

Compared with the non stress ulcer group, the positive rate of H. pylori was significantly increased in the stress ulcer group, and serum TNF-α, MMP-9, miR-204 and miR-182 was also significantly increased (P<0.05). Compared with the H. pylori negative group, the incidence rate of stress ulcer (OB positive rate) in the H. pylori positive group was significantly increased, and the serum TNF-α, MMP-9, miR-204 and miR-182 was also significantly increased (P<0.05). The ROC curve analysis results showed that miR-204 showed the highest sensitivity (100%) in predicting stress ulcers, while TNF-α and MMP-9 showed the highest specificity (100%); miR-204 showed the highest sensitivity (100%) in predicting H. pylori infection, while TNF-α and MMP-9 showd the highest specificity (90%).

H. pylori is significantly associated with stress ulcer bleeding in elderly PBSH patients, TNF-α, MMP-9 and miR-204 may be new potential biomarkers for the progression of PBSH.