miR-146a及APACHEⅡ评分预测脓毒症并发急性肾损伤患者28天死亡的价值  

Value of miR-146a and APACHEⅡ score in predicting 28-day mortality in sepsis patients with acute kidney injury

作　　者：邱玉霞 孙月玲 宫保强 林森[1] 关万涛 Qiu Yu-xia;Sun Yue-ling;Gong Bao-qiang;Lin Sen;Guan Wan-tao(Intensive Care Unit,the Third People's Hospital of Hainan Province,Sanya 572000,China)

机构地区：[1]海南省第三人民医院重症医学科,海南三亚572000

出　　处：《中国急救医学》2020年第10期942-946,共5页Chinese Journal of Critical Care Medicine

基　　金：海南省医学科研基金资助(17A618252)。

摘　　要：目的探讨miR-146a及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分预测脓毒症并发急性肾损伤(AKI)患者28天死亡的价值.方法选取2017年1月至2019年5月海南省第三人民医院收治的脓毒症并发AKI患者162例,根据其28天的生存情况分为生存组(n=105)和死亡组(n=57),采用APACHEⅡ评分标准将患者分为高危组(n=72,APACHEⅡ评分>20分)和低中危组(n=90,APACHEⅡ评分≤20分).采用实时荧光定量聚合酶链式反应(PCR)检测各组血清miR-146a表达水平.应用受试者工作特征(ROC)曲线分析miR-146a及APACHEⅡ评分预测脓毒症并发AKI患者死亡的价值,Pearson相关分析血清miR-146a表达水平与APACHEⅡ评分的相关性.结果死亡组血清miR-146a表达水平(4.36±1.20 vs.1.85±0.64)及APACHEⅡ评分(30.70±5.40 vs.15.90±3.20,分)均明显高于生存组(P<0.01).高危组血清miR-146a表达水平(4.08±1.05 vs.2.17±0.82)及APACHEⅡ评分(28.60±4.30 vs.18.40±3.80,分)、病死率(56.9%vs.17.8%)均明显高于低中危组(P<0.01).ROC曲线分析显示,miR-146a联合APACHEⅡ评分预测脓毒症并发AKI患者死亡的曲线下面积(0.924,95%CI0.866~0.980)最大,敏感度和特异度较高(92.5%和87.0%).相关分析显示,死亡组血清miR-146a表达水平与APACHEⅡ评分呈正相关(r=0.837,P<0.01).结论血清miR-146a表达水平升高与脓毒症并发AKI患者的病情严重程度及预后有关,miR-146a联合APACHEⅡ评分对预测脓毒症并发AKI患者28天死亡具有较高的价值.Objective To explore the value of microRNA-146a(miR-146a)and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)in predicting 28-day mortality in sepsis patients with acute kidney injury(AKI).Methods 162 patients with sepsis complicated with AKI admitted to our hospital from January 2017 to May 2019 were divided into survival group(n=105)and death group(n=57)according to their 28-day survival.According to APACHEⅡ criteria the patients were divided into high-risk groups(n=72,APACHEⅡ>20 score)and low-medium risk group(n=90,APACHEⅡ>20 score).Real-time fluorescence quantitative polymerase chain reaction(PCR)was used to detect the expression of serum miR-146a in each group.The ROC curve were used to analyze the predictive value of miR-146a and APACHEⅡ scores for the mortality of sepsis patients complicated with AKI.Pearson correlation analysis was used to analyze the correlation between the expression level of serum miR-146a and APACHEⅡ scores.Results The expression level of serum miR-146a(4.36±1.20 vs.1.85±0.64)and APACHEⅡ score(scores:30.70±5.40 vs.15.90±3.20)in the death group were significantly higher than those in the survival group(P<0.01).The expression level of serum miR-146a(4.08±1.05 vs.2.17±0.82),APACHEⅡ score(scores:28.60±4.30 vs.18.40±3.80)and mortality rate(56.9%vs.17.8%)in high risk group were significantly higher than those in low-medium risk group(P<0.01).ROC curve analysis showed that the area under the curve(0.924,95%CI 0.866-0.980)of miR-146a combined with APACHEⅡ for predicting the death of sepsis patients complicated with AKI were the largest,with a high sensitivity and specificity of 92.5% and 87.0%.The correlation analysis showed that the expression level of serum miR-146a was positively correlated with APACHEⅡ score(r=0.837,P<0.01).Conclusion The increased expression of serum miR-146a is related to the severity and prognosis of sepsis patients complicated with AKI,and the combination of miR-146a and APACHEⅡ score has high value in predicting 28-day mortali

关 键 词：脓毒症 急性肾损伤 MIR-146A 急性生理学与慢性健康状况评分系统Ⅱ 

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