miR-21和miR-107-5p对脓毒症所致急性肾损伤患者28天生存率影响  

Effects of predictive value of miRNA-21 and miRNA- 107-5 p on 28- day mortality in patients with sepsis-induced acute kidney injury

作　　者：魏薇[1] 翟哲[1] 毕宏远[1] 高岩[1] Wei Wei;Zhai Zhe;Bi Hongyuan;Gao Yah(Department of Intensive Care Unit,the Fourth Affiliated Hospital of Harbin Medical University,Harbin 150080,China)

机构地区：[1]哈尔滨医科大学附属第四医院重症医学科,150081

出　　处：《国际遗传学杂志》2018年第4期266-272,共7页International Journal of Genetics

基　　金：黑龙江省青年科学基金（QC2018099）

摘　　要：目的 探讨miR-21和miR-107-5 p对评估脓毒症伴有急性肾损伤（acute kidney injury,AKI）患者28天死亡率的预测价值.方法 收集哈尔滨医科大学附属第四医院125例急性肾损伤患者血清样本,分为观察组（脓毒症所致AKI）75例和对照组（脓毒症非AKI）50例,记录患者一般情况,并用实时定量反转录PCR（quantitative reverse transcription PCR,qRT-PCR）检测其中miR-21和miR-107-5 p的表达情况,随访28天,记录患者生存情况,采用Pear-son相关分析检验miR-21和miR-107-5 p与观察组患者血清肌酐（Scr）、胱抑素C（Cys-C）、尿素氮（BUN）和肾损伤分子1（KIM-1）的相关性;多因素Logistic回归分析miR-21、miR-107-5 p、Scr、Cys-C、BUN、KIM-1以及其他危险因素与脓毒症患者28天死亡率的相关性.ROC曲线分析比较miR-21、miR-107-5 p与Cys-C、BUN和Scr在脓毒症患者预后评估中的价值,最后进一步用统计学方法分析miR-21和miR-107-5 p联合与BUN、Scr及Cys-C联合对脓毒症患者预后评估的价值.结果 ①76例AKI患者中22例死亡,占整体人数的28.94％;②相比于生存组,死亡组患者血清Scr（P=0.022）、BUN（P=0.035）及Cys-C（P=0.033）表达上升,死亡组患者血清中miR-21（P=0.025）和miR-107-5p（P=0.031）表达升高,有统计学意义;③Pearson相关分析结果显示miR-21和miR-107-5 p分别与Scr、BUN、Cys-C及KIM-1表达呈正相关;④多因素回归结果显示,miR-21和miR-107-5 p均为脓毒症患者死亡的独立危险因素;⑤ROC曲线分析结果显示miR-21和miR-107-5 p曲线下面积（AUC）分别为miR-210.75（95％CI,0.73-0.78）（P=0.032）及miR-107-5p 0.73（95％CI,0.59～0.96）（P=0.041）,Cys-C、BUN、Scr和KIM-1曲线下面积分别为0.68（95％CI,0.56～0.76）、0.69（95％CI,0.53～0.74）、0.81（95％CI,0.63～0.84）及0.79（95％CI,0.72～0.81）.miR-21和miR-107-5 p二者联合检测的AUC值优于单一检测miR-21、miR-107-5 p、Cys-C、BUN、Scr和KIM-1.结论 miR-21和miR-107Objective To investigate the value of miR-21 and miR-107-5 p in predicting 28-day mortality in patients with sepsis-induced acute kidney injury . Methods 75 patients with sepsis-in-duced acute kidney injury （ AKI ） and 41 patients with sepsis but without AKI （ control ） were examined for serum levels of miR-21 and miR-107-5 p using qRT-PCR . The patients were followed up for 28 days to record their survival . Pearson correlation analysis was used to test the correlations of miR-21 and miR-107-5 p with serum creatinine （ Scr ） , cystatin C （ Cys- C ） , BUN and KIM-1 in patients with AKI . Multivariate logistic regression analysis was used to analyze the correlations of miR-21 , miR-107-5 p , Scr , Cys-C , KIM-1 and other risk factors with the 28-day mortality in patients with sepsis . The predic-tive value of these indicators for evaluating the prognosis of patients with sepsis was analyzed using ROC curve , and miR-21 combined with miR-107-5 p was assessed for their value in predicting the prognosis of the patients . Results During the 28 day follow-up , 22 of the 75 （ 28 . 84%） AKI patients died . Compared with the survivors , the patients died within 28 days showed significantly increased serum levels of Scr （P =0. 022）、BUN（P =0. 035） and Cys-C（P =0. 033）、miR-21 （P =0. 025） and miR-107-5 p （ P =0 . 031 ） . Pearson correlation analysis showed that miR-21 and miR-107-5 p were posi-tively correlated with serum Scr , Cys- C , and KIM-1 levels; multivariate regression analysis identified miR-21 and miR-107-5 p as the independent risk factors for mortality in the septic patients . The ROC curve analysis showed that the areas under the curve （ AUC ） of miR-21 and miR-107-5 p were （ 95%CI, 0. 73 ～0. 78, P =0. 032） and 0. 73（95%CI, 0. 59 ～0. 96, P =0. 041）, and that of Scr, BUN, Cys-C and KIM-1 were 0. 68 （ 95% CI, 0. 56 ～ 0. 76 ） , 0. 69 （ 95% CI, 0. 53 ～ 0. 74 ） , 0. 81（95%CI, 0. 63 ～0. 84） and 0. 79（95%CI, 0. 72 ～0. 81）, respectively.

关 键 词：脓毒症 MIR-21 miR-107-5P 急性肾损伤 生存率 

分 类 号：R459.7[医药卫生—急诊医学] R692[医药卫生—治疗学]