Objective To investigate the serum level of miR-126 in patients with hypertensive intracerebral hemorrhage and to elucidate its clinical significance in hypertensive cerebral hemorrhage. Methods From January 2015 to December 2018, 60 patients with hypertensive cerebral hemorrhage were selected as observation group, and 60 healthy subjects were selected as control group in the People's Hospital of Lin'an Affiliated to Hangzhou Medical College.The serum levels of miR-126 were determined by reverse transcription-polymerase chain reaction (RT-PCR). The serum levels of C-reactive protein (CRP), tumor necrosis factor-ɑ (TNF-ɑ) and nuclear factor kappa B (NF-κB) were measured by enzyme-linked immunosorbent assay (ELISA). Results The serum level of miR-126 in the observation group was lower than that in the control group [(0.46±0.11) vs.(1.00±0.13), t=24.562, P<0.05], and the serum levels of CRP, TNF-ɑ and NF-κB were higher than those in the control group[(8.74±0.69)mg/L vs.(3.98±0.61)mg/L, (62.43±8.26)μg/L vs.(31.28±6.54)μg/L, (19.73±1.02)μmol/L vs.(4.92±0.87)μmol/L, t=40.034, 22.902, 85.570, all P<0.05]. There were statistically significant differences in serum miR-126, CRP, TNF-ɑ, NF-κB levels among patients with different severity of hypertensive intracerebral hemorrhage[(0.57±0.09) vs.(0.44±0.12) vs.(0.36±0.11), (6.91±0.72)mg/L vs.(8.63±0.67)mg/L vs.(9.14±0.75)mg/L, (53.16±8.19)μg/L vs.(62.57±8.33)μg/L vs.(70.38±8.09)μg/L, (12.49±0.97)μmol/L vs.(19.58±1.11)μmol/L vs.(25.64±1.05)μmol/L, F=14.433, 41.379, 17.796, 623.893, all P<0.05], with the severity increased, the serum miR-126 level decreased, serum CRP, TNF-ɑ and NF-κB levels increased.The serum miR-126 level in patients with hypertensive cerebral hemorrhage of the poor prognosis group was lower than that of the good prognosis group [(0.53±0.10) vs.(0.38±0.12), t=5.279, P<0.05], and the serum levels of CRP, TNF-ɑ and NF-κB in the poor prognosis group were higher than those in the good prognosis group[(7.85±0.64)mg/L vs.(9.16±0.73)mg/L, (51.07±8.32)μg/L vs.(73.26±8.17)μg/L, (14.73±1.08)μmol/L vs.(26.52±0.99)μmol/L, t=7.392, 10.317, 43.424, all P<0.05]. The area of brain edema in patients with hypertensive intracerebral hemorrhage was negatively correlated with serum miR-126 (r=-0.623, P<0.05), and positively correlated with serum CRP, TNF-ɑ and NF-κB (r=0.581, 0.618, 0.642, all P<0.05). The serum miR-126 level was negatively correlated with CRP, TNF-ɑ and NF-κB in patients with hypertensive intracerebral hemorrhage (r=-0.593, -0.624, -0.618, all P<0.05). Conclusion The serum level of miR-126 is reduced in patients with hypertensive intracerebral hemorrhage, which may participate in the pathogenesis of hypertensive cerebral hemorrhage by participating in inflammatory reaction.The detection of serum miR-126 level has great value in evaluation of the severity and prognosis of hypertensive cerebral hemorrhage. Key words: Intracranial hemorrhage, hypertensive; MicroRNAs; C-reactive protein; Tumor necrosis factor-alpha; Nuclear transcription factor κB