血清高尔基体糖蛋白73和miR-122a对脓毒症并发肝损伤患儿预后的评估价值  

Values of serum Golgi protein 73 and miR-122a to the prognostic prediction of children with sepsis-induced liver injury

作　　者：张晓[1] 游楚明[1] 梁振宇[1] 陈娜 ZHANG Xiao;YOU Chuming;LIANG Zhenyu;CHEN Na(Department of Pediatrics,Guangdong Second Proincial General Hospital,Guangzhou 510317,China)

机构地区：[1]广东省第二人民医院儿科,广州510317

出　　处：《中华实用诊断与治疗杂志》2020年第10期1012-1016,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：广东省自筹经费类科技计划项目(2017ZC0255)。

摘　　要：目的观察脓毒症并发肝损伤患儿血清高尔基体糖蛋白73(Golgi protein 73, GP73)、miR-122a表达情况,评估其预测脓毒症并发肝损伤患儿预后的价值。方法脓毒症并发肝损伤患儿119例(合并肝损伤组)、单纯脓毒症患儿50例(单纯脓毒症组)和50例健康儿童(对照组),采用ELISA法检测血清GP73水平,采用实时荧光定量PCR法检测血清miR-122a相对表达量。比较轻度、中度、重度肝损伤脓毒症患儿血清GD73水平和miR-122a相对表达量。合并肝损伤组患儿入院28 d后死亡者30例为死亡组,存活者89例为存活组,比较死亡组和存活组患儿临床资料;采用多因素logistic回归分析脓毒症并发肝损伤患儿不良预后的危险因素;绘制ROC曲线,评估血清GP73水平和miR-122a相对表达量对脓毒症并发肝损伤患儿不良预后的预测价值。结果合并肝损伤组血清GP73水平[(68.53±21.35)μg/L]、miR-122a相对表达量(3.12±0.65)高于单纯脓毒症组[(42.13±11.05)μg/L、2.43±0.46]和对照组[(13.13±6.25)μg/L、1.08±0.21](P<0.05),单纯脓毒症组高于对照组(P<0.05)。轻度、中度、重度肝损伤脓毒症患儿血清GP73水平和miR-122a相对表达量依次增高(P<0.05)。死亡组重度肝损伤患儿比率、APACHEⅡ评分、合并急性肾损伤患儿比率、血清GP73水平和miR-122a相对表达量高于存活组(P<0.05),年龄、性别比例、机械通气比率、ICU住院时间、合并凝血功能障碍比率与存活组比较差异无统计学意义(P>0.05)。重度肝损伤(OR=1.701,95%CI:1.035~3.125,P=0.006)、高APACHEⅡ评分(OR=1.996,95%CI:1.649~3.294,P=0.003)、高GP73水平(OR=2.024,95%CI:1.951~4.099,P<0.001)、高miR-122a相对表达量(OR=2.020,95%CI:1.923~4.094,P<0.001)是脓毒症并发肝损伤患儿不良预后的独立危险因素。当GP73、miR-122a最佳截断值分别为73.26μg/L、3.37时,GP73、miR-122a、GP73+miR-122a预测脓毒症并发肝损伤患儿不良预后的AUC分别为0.767、0.774、0.981,灵敏度分别�Objective To observe the expressions of serum Golgi protein 73(GP73) and miR-122 a in children with sepsis-induced liver injury and to assess the values of GP73 and miR-122 a to the prediction of the prognosis of sepsis-induced liver injury in children. Methods The serum GP73 level was detected by ELISA and the relative expression of serum miR-122 A was detected by real-time fluorescence quantitative PCR in 119 children with sepsis-induced liver injury(liver injury group), 50 children with sepsis(sepsis group) and 50 healthy children(control group). The serum GP73 level and the relative expression of miR-122 a were compared among children with mild,moderate and severe liver injury. In liver injury group, 30 children died 28 days after admission(death group), and the other 89 children survived(survival group). The clinical data were compared between death group and survival group. Multivariate logistic regression was used to analyze the risk factors for poor prognosis of the children with sepsis-induced liver injury. ROC was drawn to assess the values of the relative expressions of serum GP73 and miR-122 a to the prediction of poor prognosis in children with sepsis-induced liver injury. Results The serum GP73 level and the relative expression of miR-122 a were higher in liver injury group((68.53±21.35) μg/L, 3.12±0.65) than those in sepsis group((42.13±11.05) μg/L, 2.43±0.46) and control group((13.13±6.25) μg/L, 1.08±0.21)(P<0.05), were higher in sepsis group than those in control group(P<0.05),and increased gradually in turn in mild,moderate and severe liver injury children(P<0.05).The percentage of severe liver injury,APACHEⅡscore,percentage of complication of acute kidney injury,serum GP73 level and relative expression of miR-122 awere higher in death group than those in survival group(P<0.05),while there were no significant differences in the age,sex ratio,percentage of mechanical ventilation,length of ICU stay,and percentage of complication of coagulation dysfunction between two groups(P>0.05).Seve

关 键 词：脓毒症 高尔基体糖蛋白73 miR-122a 肝损伤 APACHEⅡ评分 预后 

分 类 号：R720.597[医药卫生—急诊医学]