MicroRNA-150联合脉搏指示连续性心输出量检测指标判断脓毒症休克患者预后的临床价值  

Prognostic value of Picco monitoring combined with plasma microRNA-150 detection in septic shock patients

作　　者：杨婉花[1] 吴海英[1] 张宏泽[1] 刘鸿翔[1] 卫玉洁 石斌[1] 

机构地区：[1]上海市交通大学附属第一人民医院松江分院急诊危重病科

出　　处：《浙江大学学报（医学版）》2015年第6期659-664,共6页Journal of Zhejiang University(Medical Sciences)

基　　金：上海市松江区卫生局领先专业课题(2012-Ⅲ-02)

摘　　要：目的：探讨不同预后脓毒症休克患者microRNA-150水平和脉搏指示连续性心输出量（Picco）指标的变化规律，研究二者联合判断患者预后的临床价值。方法：回顾性分析2012年8月至2014年8月由上海市交通大学附属第-人民医院松江分院急诊危重病科收治的脓毒症休克患者的临床资料。研究共纳入患者48例，其中男性29例，女性19例。收集患者Picco监测参数及其他血流动力学参数，并用实时定量PCR检测患者收治时的microRNA．150水平，同时采用单因素分析、logistic多因素分析microRNA-150水平、Picco参数与患者预后的关系，Spearman相关性分析确定microRNA-150与Picco参数的关系。ROC曲线分析microRNA-150、Picco参数及二者联合判断脓毒症休克患者预后的临床价值。结果：收入急诊ICU治疗28d后，23例患者存活，25例患者死亡。死亡患者的microRNA．150水平较低，为存活组的（61±3）％，差异有统计学意义（t=-10．32，P〈0．05）。Kanplan．Meier生存曲线提示，低microRNA-150水平组和高microRNA-150水平组患者生存率分别为21．8％和68．2％，差异具有统计学意义（P〈0．05）。单因素分析结果提示。低microRNA-150水平是患者预后不良的危险因素（OR=2．176。95％CI：1．121—4．223，P〈0．05）。存活组患者的心指数较高，血管外肺水指数（EVLWI）及肺毛细血管通透性指数（PVPI）均低于死亡组患者（均P〈0．05），低心指数、高EVLWI、高PVPI为患者死亡的独立危险因素。MicroRNA-150水平与心指数呈正比（r=0．712，P〈0．05），但与EVLWI、PVPI呈反比（r=-0．622、-0．689。均P〈0．05）。MicroRNA．150与Picco参数联合较两者单独判断脓毒症患者死亡的临床价值更高。结论：较低的microRNA-150水平预示着脓毒症休克患者预后不良，Picco参数能较好地反应脓毒症休克患者的预后；microRNA-150与Picco参数联合有助于判断�Objective： To assess the prognostic value of pulse indicator continuous cardiac output （Picco） monitoring combined with plasma microRNA-150 detection in septic shock patients. Methods： Clinical data of 48 patients with septic shock admitted in General Intensive Care Unit （ GICU）, Shanghai First People＇ s Hospital Songjiang Branch Affiliated to Shanghai Jiaotong University from August 2012 to August 2014 were analyzed retrospectively. The plasma levels of microRNA-150 in 48 patients at admission were assayed by qRT-PCR; and Picco monitoring was performed to record hemodynamic changes. The correlation of microRNA-150 or Picco parameters with prognosis of patients was assessed by univariate analysis and multivariate logistic analysis. Spearman correlation test showed the relationship between microRNA-150 and Picco parameters. Finally, the clinical value of combining microRNA-150 with Picco monitoring to predict the outcome of septic shock patients was analyzed by ROC curves. Results： Twenty-three patients survived and 25 died in 28 d after admission in GICU. Compared with survival patients, microRNA-150 was significantly lower in fatal patients （ t = - 10.32, P 〈 0.05 ）. Univariate analysis showed that low microRNA-150 level was a risk factor for poor prognosis （ OR = 2. 176,95% CI： 1. 121 - 4. 223, P 〈 0.05 ）. Compared with fatal cases, the cardiac index of survival patients was higher, while EVLWI and PVPI were lower. MicroRNA-150 level was positively correlated with cardiac index（r =0. 712 ,P 〈0.05）, negatively correlated with EVLWI and PVPI （r = - 0. 622 and - O. 689, both P 〈 0.05 ）. ROC curves showed a satisfactory diagnostic efficiency of combining microRNA-150 with Picco monitoring. Conclusion： Lower microRNA-150 may indicate a poor prognosis, and Picco monitoring combined with microRNA 150 detection may improve the prognostic efficiency in septic shock patients.

关 键 词：微RNAS 脓毒症 休克 预后 血管外肺水 毛细血管通透I性 

分 类 号：R459.7[医药卫生—急诊医学]