To study the relationship between the expression of miR-146a in perihematomal brain tissue and autophagy and short-term prognosis in patients with hypertensive intracerebral hemorrhage(ICH). Meth? ods: A total of 204 patients with hypertensive ICH who underwent hematoma clearance in our hospital and were followed up for 3 months were selected as the ICH group. Another 18 non-cerebral hemorrhage cases from autopsies were selected as the control group. Clinical data from patients were collected. The expression of miR-146a, autophagic gene Beclin-1, Cathepsin D, and LC3-II/LC3-I in perihematomal brain tissue and normal brain tissue was detected. Three months after discharge, the patients in the ICH group were divided into 187 poor prognosis patients and 117 good prognosis patients based on the modified Rankin Scale (mRS) score. The predictive value of miR-146a on prognosis was analyzed by ROC curve, and the influencing factors were analyzed by Logistic regression. Results: The expression level of miR-146a in perihematomal brain tissue of the ICH group was significantly lower than that of the control group; the expression levels of autophagy gene Beclin-1, Cathepsin D, and LC3-II/LC3-I were significantly higher than those of the control group (P<0.05), and miR-146a was negatively correlated with Beclin-1, Cathepsin D, and LC3-II/LC3-I. The difference in NIHSS score at admission, WBC, ABG at admission, hematoma volume, ventricular rupture, and expression levels of miR-146a, Beclin-1, Cathepsin D, and LC3-II/LC3-I between poor prognosis patients and good prognosis patients in ICH group were statistically significance (P<0.05). ROC curve analysis showed that the expression of miR-146a had predictive value for the prognosis of patients with ICH; Logistic regression analysis showed that the NIHSS score, hematoma volume, ventricular rupture, miR-146a, and Beclin-1 were the influencing factors for prognosis in the ICH group (P<0.05). Conclusion: Expression of miR-146a decreases in the perihematomal brain tissue following hypertensive ICH and is related to the hyperactivity of autophagy and poor short-term prognosis.