脓毒症患者外周血淋巴细胞中微小RNA-126表达量与细胞凋亡及预后的相关性分析  

Correlation analysis of microRNA-126 expression in peripheral blood lymphocytes with apoptosis and prognosis in patients with sepsis

作　　者：邹琪[1] 赵士兵[1] 吴强[1] 汪华学[1] 何先弟[1] 刘成[1] Zou Qi;Zhao Shibing;Wu Qiang;Wang Huaxue;He Xiandi;Liu Cheng(Department of Critical Care Medicine,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233000,Anhui,China)

机构地区：[1]蚌埠医学院第一附属医院重症医学科,安徽蚌埠233000

出　　处：《中华危重病急救医学》2020年第8期938-942,共5页Chinese Critical Care Medicine

基　　金：安徽高校自然科学研究重点项目(KJ2018A0244,KJ2019A0351);贝朗蛇牌学院重症科学研究基金(BBDF-ICU-2018-002);安徽省蚌埠市科技创新指导类项目(20180332)。

摘　　要：目的分析脓毒症患者外周血淋巴细胞中微小RNA-126(miR-126)的表达与凋亡及预后的关系,探讨其可能的潜在调控机制.方法选择2019年1月至12月在蚌埠医学院第一附属医院重症监护病房(ICU)住院治疗的30例一般感染患者和20例脓毒症患者.取外周血分离淋巴细胞,用反转录-聚合酶链反应(RT-PCR)检测miR-126和天冬氨酸特异性半胱氨酸蛋白酶3(caspase-3)的表达量,同时测定肝肾功能等实验室指标,并计算序贯器官衰竭评分(SOFA)和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ),观察28 d预后.用Pearson法分析miR-126与caspase-3、APACHEⅡ评分的相关性;用受试者工作特征曲线(ROC)分析miR-126对预后的预测价值;同时根据miR-126预测预后的最佳截断值将患者分为两组,绘制患者28 d Kaplan-Meier生存曲线.结果与一般感染组比较,脓毒症组患者外周血淋巴细胞中miR-126表达量显著降低〔miR-126 mRNA(2-ΔCt):1.239±0.134比1.599±0.110,P<0.01〕,caspase-3表达量和APACHEⅡ评分明显升高〔caspase-3 mRNA(2-ΔCt):1.172±0.132比0.901±0.143,APACHEⅡ(分):19.75±3.74比12.63±3.94,均P<0.01〕.Pearson相关分析显示,感染患者淋巴细胞中miR-126表达量与caspase-3表达量(r=-0.678,P<0.001)、APACHEⅡ评分(r=-0.581,P<0.001)均呈显著负相关.ROC曲线分析显示,外周血淋巴细胞miR-126表达量预测患者预后的ROC曲线下面积(AUC)为0.823(P<0.001),最佳截断值为1.395时,敏感度为75.0%,特异度为71.4%,阳性预测值为81.1%,阴性预测值为63.6%,阳性似然比为2.622,阴性似然比为0.350.此外,以miR-126最佳截断值分为高miR-126组(miR-126>1.395,31例)和低miR-126组(miR-126≤1.395,19例),Kaplan-Meier生存曲线分析显示,高miR-126组28 d累积生存率高于低miR-126组(Log-Rank:χ^2=11.702,P=0.001).结论脓毒症患者外周血淋巴细胞中miR-126可能通过促进淋巴细胞凋亡增加来影响免疫状态,其表达量高低能够反映脓毒症患者严重程度及预后.Objective To analyze the relationship between the expression of microRNA-126(miR-126)in peripheral blood lymphocytes with apoptosis and prognosis in patients with sepsis,and to explore its potential regulatory mechanism.Methods Thirty patients with general infection and 20 patients with sepsis admitted to the department of intensive care unit(ICU)of the First Affiliated Hospital of Bengbu Medical College from January to December 2019 were enrolled.Peripheral blood was taken to separate lymphocytes,and the expressions of miR-126 and caspase-3 were detected by reverse transcription-polymerase chain reaction(RT-PCR).At the same time,the liver and kidney function and other laboratory indexes were measured,and the sequential organ failure assessment(SOFA)and acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores were calculated.The 28-day prognosis was observed.Pearson method was used to analyze the correlation between miR-126 and caspase-3,APACHEⅡscore.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of miR-126 on prognosis;at the same time,according to the best cut-off value of miR-126 in predicting prognosis,the patients were divided into two groups,and the 28-day Kaplan-Meier survival curve was drawn.Results The expression of miR-126 in peripheral blood lymphocytes of patients with sepsis was lower than that of patients with general infection[miR-126 mRNA(2-ΔCt):1.239±0.134 vs.1.599±0.110,P<0.01],while the expression of caspase-3 and APACHEⅡscore were significantly increased[caspase-3 mRNA(2-ΔCt):1.172±0.132 vs.0.901±0.143,APACHEⅡ:19.75±3.74 vs.12.63±3.94,both P<0.01].Pearson correlation analysis showed that the expression of miR-126 was negatively correlated with the expression of caspase-3(r=-0.678,P<0.001)and APACHEⅡscore(r=-0.581,P<0.001).ROC curve analysis showed that the area under the ROC curve(AUC)for predicting the prognosis by miR-126 expression in peripheral blood lymphocytes was 0.823(P<0.001).When the best cut-off value was 1.395,the sens

关 键 词：微小RNA-126 淋巴细胞 脓毒症 天冬氨酸特异性半胱氨酸蛋白酶3 预后 

分 类 号：R459.7[医药卫生—急诊医学]