支气管肺泡灌洗液中外泌体内miR-654-5p对危重患者合并肺炎的诊断价值  

Diagnostic potential of bronchoalveolar lavage fluid exosomal microRNA-654-5p for pneumonia in the intensive care unit

作　　者：孙银芳 向锁玉 冼盈[1] 李建伟[3] 吴忠道 张扣兴[1] SUN Yin⁃fang;XIANG Suo⁃yu;XIAN Ying;LI Jian⁃wei;WU Zhong⁃dao;ZHANG Kou⁃xing(General Intensive Care Unit,the Third Hospital of Sun Yat⁃sen University,Guangzhou,Guangdong 510530;Department of Parasitology,Zhongshan School of Medicine,Sun Yat⁃sen University,Guangzhou,Guangdong 510080;Department of Critical Care Medicine,Zhongshan People’s Hospital,Zhongshan,Guangdong 528400,China)

机构地区：[1]中山大学附属第三医院综合ICU,广东广州510530 [2]中山大学中山医学院寄生虫学教研室,广东广州510080 [3]中山市人民医院重症医学科,广东中山528400

出　　处：《热带医学杂志》2022年第4期490-494,共5页Journal of Tropical Medicine

基　　金：广东省科技计划项目(2005A20901005)

摘　　要：目的探讨支气管肺泡灌洗液(BALF)中外泌体微小RNA-654-5p(miR-654-5p)对需要机械通气的危重患者合并肺炎的诊断价值。方法纳入2020年10月-2021年8月中山大学附属第三医院重症医学科收治需要机械通气的62例危重患者作为研究对象,其中11例为非呼吸道感染术后需辅助通气患者,51例为机械通气伴肺部感染者。收集患者的BALF和血浆,采用差速离心法分别获得两种来源样本的外泌体、无外泌体上清和BALF中的细胞沉淀。用实时荧光定量聚合酶链反应(q RT-PCR)检测各样本中miR-654-5p的表达水平;评估BALF外泌体中miR-654-5p的表达对危重患者合并肺炎的诊断价值。结果伴有肺炎的危重患者仅在BALF外泌体中miR-654-5p表达量明显高于非呼吸道感染术后患者(P=0.036)。ROC曲线分析显示,BALF外泌体中miR-654-5p诊断危重患者合并肺炎的ROC曲线下面积为0.704,95%CI:0.575~0.813(P=0.013);当临界值取1.743时,敏感度为72.55%,特异度为63.64%,阳性似然比为2.00,阴性似然比为0.43。结论BALF外泌体中miR-654-5p可作为诊断机械通气危重患者合并肺炎的分子标志物。Objective To observe differential expressions of bronchoalveolar lavage fluid(BALF)exosomal microRNA-654-5p(miR-654-5p)in patients with mechanical ventilation and its diagnostic value for pneumonia in critical patients.Methods A total of 62 critically ill patients who needed mechanical ventilation admitted to the Department of Intensive Care Units(ICU)of the Third Affiliated Hospital of Sun Yat-sen University from October 2020 to August 2021 were enrolled,including 51 pneumonia patients(pneumonia group)and 11 non-respiratory infection patients(control group)who needed mechanical ventilation after surgery.Exosomes and exosome-free supernatant derived from BALF and plasma were obtained by differential centrifugation.Cell-debris pellets in BALF were collected as liquid biopsy elements.The expression levels of miR-654-5p in different samples were determined using a real-time fluorescent quantitative polymerase chain reaction(qRT-PCR).The value of bronchoalveolar lavage fluid exosomal miR-654-5p expression in the diagnosis of pneumonia was evaluated with receiver-operating characteristic curve(ROC).Results Only in exosomes from BALF,the expressions of miR-654-5p were significantly increased in pneumonia group compared with control group(P=0.036).ROC curve analysis showed that the area under ROC curve(AUC)of bronchoalveolar lavage fluid exosomal miR-654-5p for diagnosis of pneumonia in critical patients was 0.704,95%CI:0.575-0.813(P=0.013),with the optimal sensitivity and specificity of 72.55%and 63.64%,respectively,with the critical value of 1.743,positive likelihood ratio of 2.00,and the negative likelihood ratio of 0.43.Conclusion Bronchoalveolar lavage fluid exosomal miR-654-5p could be used as a new biomarker for the diagnosis of pneumonia in critical patients.

关 键 词：肺炎 外泌体 miR-654-5p 诊断生物标志物 

分 类 号：R459.7[医药卫生—急诊医学] R563.1[医药卫生—治疗学]