微小RNA-133a和微小RNA-499a-5p在脓毒性心肌病中的诊断和预后价值  

Diagnostic and predictive value of micro RNA-133a and micro RNA-499a-5p in patients with sepsis induced cardiomyopathy

作　　者：薛雨晨 薛晓梅[1] 何斌[1] Xue Yuchen;Xue Xiaomei;He Bin(Department of Anesthesiology and SICU, Xinhua Hospital Shanghai Jiaotong University School of Medicine, Shanghai 200092, China)

机构地区：[1]上海交通大学医学院附属新华医院麻醉与重症医学科,200092

出　　处：《国际麻醉学与复苏杂志》2019年第8期759-764,共6页International Journal of Anesthesiology and Resuscitation

基　　金：上海申康临床三年行动计划(16CR3006A);上海市科学技术委员会科研计划项目(17411954700);上海交通大学转化医学交叉研究基金(ZH2018ZDB01).

摘　　要：目的探讨微小RNA(micro RNA,miR)-133a和miR-499a-5p对脓毒性心肌病(sepsis-induced cardiomyopathy,SIC)的诊断及预后评估价值。方法收集70例脓毒症患者血液样本,根据诊断标准分为SIC组(54例)和对照组(脓毒症未发生心肌病,16例)。记录患者一般情况,用实时定量荧光PCR技术检测血清miR-133a和miR-499a-5p的表达情况,随访28 d,记录患者生存情况,并比较两组患者28 d病死率。采用Pearson相关性分析检验miR-133a和miR-499a-5p与血清肌钙蛋白I (troponin I,cTnI)、肌酸激酶同工酶(creatine kinase-MB,CK-MB)、N末端B型钠尿肽前体(N-terminal B-type natriuretic peptide,NT-proBNP)及左室射血分数(left ventricular ejection fraction,LVEF)的相关性;受试者工作特征曲线(receiver operating characteristic,ROC曲线)分析比较miR-133a和miR-499a-5p对SIC的诊断价值;多因素Logistic回归分析SIC患者28 d病死率的危险因素;ROC曲线分析危险因素对患者28 d病死率的预测价值。结果与对照组比较,SIC组患者miR-133a和miR-499a-5p表达升高,28 d病死率增高(P<0.05)。Pearson相关分析结果显示:miR-133a和miR-499a-5p与cTnI呈正相关(miR-133a,r=0.329,P=0.005;miR-499a-5p,r=0.574,P=0.000)。ROC曲线分析结果显示:miR-133a、miR-499a-5p以及miR-133a和miR-499a-5p联合检测诊断SIC的ROC曲线下面积分别为0.676、0.737和0.758。多因素回归结果显示:miR-133a为SIC患者28 d病死率的独立危险因素。ROC曲线分析结果显示,miR-133a预测患者28 d病死率的ROC曲线下面积为0.826(95%CI 0.703~0.948)。结论miR-133a和miR-499a-5p可作为诊断SIC的生物标志物,miR-133a对SIC患者的28 d病死率具有预测价值。Objective To investigate the value of micro RNA (miR)-133a and miR-499a-5p in diagnosing sepsis-induced cardiomyopathy (SIC) and predicting mortality in patients with SIC. Methods Blood samples collected from 70 sepsis patients with sepsis were included and divided into SIC group(n=54) and control group(n=16, sepsis without cardiomyopathy) according to diagnostic criteria to calculate the incidence of SIC. Blood samples were examined for serum levels of miR-133a and miR-499a-5p using Real-Time polymerase chain reaction (PCR) and baseline data were recorded. The comparison was made between SIC group and control group. The patients were followed up for 28 d to record their survival. Pearson correlation analysis was used to test the correlations of miR-133a and miR-499a-5p with troponin I (cTnI), creatine kinase-MB (CK-MB), N-terminal B-type natriuretic peptide(NT-proBNP) and left ventricular ejection fraction (LVEF) in patients with SIC. The diagnostic value of miR-133a and miR-499a-5p for SIC was analyzed using receiver operating characteristic(ROC) curve. Multivariate Logistic regression analysis was used to analyze the correlations of miR-133a, miR-499a-5p and other risk factors with the 28 d mortality in patients with sepsis. The predictive value of these indicators for evaluating the prognosis of SIC was analyzed using ROC curve. Results The expression levels of miR-133a and miR-499a-5p in patients with SIC were both significantly higher than the expression levels in patients without SIC(P<0.05). Pearson correlation analysis showed that miR-133a and miR-499a-5p were positively correlated with cTnI levels (miR-133a, r=0.329, P=0.005;miR-499a-5p, r= 0.574, P=0.000). The area under the ROC curve of miR-133a, miR-499a-5p and miR-133a combined with miR-499a-5p was 0.676, 0.737 and 0.758. During the follow-up period for 28 d, 19 of the 54 (35.2%) SIC patients died. Logistic regression analysis indicated that miR-133a was independent risk factor for the 28 d mortality of SIC patients. The ROC curve analysis showed th

关 键 词：脓毒症 脓毒性心肌病 微小RNA-133a 微小RNA-499a-5p 生物标志物 

分 类 号：R459.7[医药卫生—急诊医学] R542.2[医药卫生—治疗学]