miR-181b-5p is Upregulated in First-Episode Drug-Naive Schizophrenia and Correlates with Symptom Severity and...

This study aimed to explore miR-181b-5p's diagnostic value in schizophrenia, analyze its correlations with symptoms and cognition, and evaluate biomarker-guided personalized nursing efficacy to inform early diagnosis and precision care. A total of 126 patients with first-episode, drug-naive schizophrenia and 126 age- and gender-matched healthy controls were enrolled between January 2024 and June 2025. Plasma miR-181b-5p and Early Growth Response 1 (EGR1) mRNA levels were measured by qRT-PCR, and their targeting was validated via dual-luciferase assay. Symptoms and cognition were assessed with the Positive and Negative Syndrome Scale (PANSS) and the MATRICS Consensus Cognitive Battery (MCCB). Receiver Operating Characteristic (ROC) curve and Pearson correlation were used for statistical analysis. Patients were grouped by median miR-181b-5p expression, with the high-expression group receiving personalized nursing. Outcomes were compared after 8 weeks. The results showed that Plasma miR-181b-5p was significantly upregulated, while EGR1 mRNA was downregulated in schizophrenia patients. miR-181b-5p showed good diagnostic performance [Area Under the Curve (AUC) = 0.898, 95% CI: 0.858-0.938]. Its expression positively correlated with all PANSS subscales and total scores and negatively correlated with all seven MCCB cognitive domains and overall scores. The inhibitory effect of miR-181b-5p on EGR1 expression was demonstrated to occur via direct binding to its 3'UTR by the dual-luciferase experiments. Exploratory subgroup analysis demonstrated significant improvements in both the high-expression subgroup receiving add-on individualized precision nursing and the low-expression subgroup receiving only routine care. In conclusion, miR‑181b‑5p is upregulated in schizophrenia and shows sequence‑specific binding to the EGR1 3'‑UTR in vitro. While improvements in the high‑expression subgroup tentatively suggest miR‑181b‑5p as a reference biomarker for selecting candidates for intensified rehabilitation, these nursing findings remain exploratory and cannot confirm the efficacy of biomarker‑guided personalized nursing due to the non‑randomized design.