血清miR-155-5p和miR-133a-3p对 脓毒症诊断及预后的评估价值  

Value of serum miR-155-5pand miR-133a-3p expression for the diagnosis and prognosis evaluation of sepsis

作　　者：兰超[1] 史晓朋[1] 郭楠楠[1] 裴辉[1] 张华丽[1] 

机构地区：[1]郑州大学第一附属医院急诊医学部,河南省高等学校临床医学重点学科开放实验室,河南郑州450052

出　　处：《中华危重病急救医学》2016年第8期694-698,共5页Chinese Critical Care Medicine

基　　金：河南省基础与前沿技术研究计划项目（142300410068）;国家临床重点专科建设项目（2012649）

摘　　要：目的：探讨血清微小RNA-155-5p和-133a-3p（miR-155-5p、miR-133a-3p）表达量对脓毒症诊断及预后的评估价值。方法采用前瞻性观察性研究方法，选择2015年1月至2016年1月郑州大学第一附属医院急诊重症加强治疗病房（EICU）收治的脓毒症患者105例，按严重程度分为脓毒症组（35例）、严重脓毒症组（35例）、脓毒性休克组（35例），选择同期35例健康体检者作为对照组；根据患者预后分为好转出院组（70例）和院内死亡组（35例）。收集所有研究对象的临床资料，采用反转录-聚合酶链反应（RT-PCR）检测血清miR-155-5p和miR-133a-3p的mRNA表达；绘制受试者工作特征曲线（ROC），评估miRNAs对脓毒症的诊断价值；采用二元logistic回归分析影响脓毒症患者预后的危险因素。结果①随脓毒症病情加重，患者血清miR-155-5p和miR-133a-3p的mRNA表达量均呈逐渐升高趋势，脓毒症、严重脓毒症、脓毒性休克组血清miR-155-5p的mRNA表达量（2-ΔCt）分别为1.89±0.48、2.21±0.41、2.79±0.73（F＝23.737，P＝0.000）；miR-133a-3p的mRNA表达量（2-ΔCt）分别为1.38±0.31、1.74±0.65、2.08±0.47（F＝27.710，P＝0.000）。ROC曲线分析显示，血清miR-155-5p和miR-133a-3p表达量诊断脓毒症的ROC曲线下面积（AUC）分别为0.855〔95%可信区间（95%CI）＝0.761～0.949〕和0.769（95%CI＝0.666～0.872）。当miR-155-5p表达量的截断值为1.64时，其诊断脓毒症的敏感度为85.3%，特异度为80.6%；当miR-133a-3p表达量的截断值为0.82时，其诊断脓毒症的敏感度为97.9%，特异度为54.8%。②与好转出院组比较，院内死亡组患者病情更严重，降钙素原（PCT）、C-反应蛋白（CRP）、D-二聚体、血乳酸（Lac）、序贯器官衰竭评分（SOFA）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分以及miR-155-5p、miR-133a-3p的mRNA表达量均明显升高（均P＜0.05）；而两组间性别、�Objective To explore the value of serum microRNA-155-5p and -133a-3p （miR-155-5p and miR-133a-3p） expression for the diagnosis and prognosis evaluation of sepsis. Methods A prospective observational study was conducted. 105 sepsis patients admitted to emergency intensive care unit （EICU） of the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2016 were enrolled. They were divided into three groups according to the severity： 35 patients with sepsis, 35 with severe sepsis, and 35 with septic shock. At the same time, 35 healthy persons were selected as the control group. According to the prognosis, the patients were divided into improved group （n = 70） and in-hospital death group （n = 35）. The clinical data of all the subjects were collected. The mRNA expressions of miR-155-5p and miR-133a-3p were determined by reverse transcription-polymerase chain reaction （RT-PCR）. The receiver-operating characteristic curve （ROC） was plotted to evaluate their clinical value for the diagnosis and prognosis of sepsis. The binary logistic regression was used to analyze the risk factors affecting the prognosis of sepsis patients. Results ① The mRNA expressions of serum miR-155-5p and miR-133a-3p were gradually increased with the aggravation of sepsis. The mRNA expression of miR-155-5p （2-ΔCt） in sepsis, severe sepsis, sepsis shock groups was 1.89±0.48, 2.21±0.41, 2.79±0.73 （F = 23.737, P = 0.000）, and the mRNA expression of miR-133a-3p （2-ΔCt） was 1.38±0.31, 1.74±0.65, 2.08±0.47, respectively （F = 27.710, P = 0.000）. It was shown by ROC curve analysis that the area under the ROC curve （AUC） of serum miR-155-5p and miR-133a-3p for the diagnosis of sepsis was 0.855 [95% confidence interval （95%CI） = 0.761-0.949] and 0.769 （95%CI = 0.666-0.872） respectively. The cut-off value of miR-155-5p for the diagnosis of sepsis was 1.64, the sensitivity was 85.3%, and specificity was 80.6%. While the cut-off value of miR-133a-3p was 0.82, the sensitivity

关 键 词：脓毒症 微小RNA 诊断 预后 

分 类 号：R459.7[医药卫生—急诊医学]