循环miR-126表达水平与脓毒症患者发生ARDS的风险及脓毒症严重程度和预后的关联  

Correlation among expression level of circulating miR-126,risk of acute respiratory distress syndrome,and septic severity and prognosis in patients with sepsis

作　　者：林润 李乐辉 吴国平[1] 罗凌青 饶平 Lin Run;Li Lehui;Wu Guoping;Luo Lingqing;Rao Ping(Department of Emergency,The First Affiliated Hospital of Hainan Medical University)

机构地区：[1]海南医学院第一附属医院急诊科,海口570102

出　　处：《重庆医科大学学报》2020年第11期1583-1588,共6页Journal of Chongqing Medical University

摘　　要：目的:评估血浆微小RNA(microRNA,miR)-126表达水平对脓毒症患者急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)发生风险的预测作用,及其与脓毒症疾病严重程度、炎症水平和患者预后的关联。方法:连续纳入172例脓毒症患者。患者入院24 h内采集外周血并分离血浆,采用定量聚合酶链式反应检测血浆miR-126表达水平。采用酶联免疫吸附试验检测血浆炎症因子[包括肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素(interleukin,IL)-1β、IL-6和IL-17]表达量。同时记录患者28 d死亡率。结果:住院期间共50例(30.8%)患者发生ARDS,血浆miR-126在ARDS患者中的表达水平明显高于非ARDS患者(P<0.001)。受试者工作特征曲线(receiver-operating characteristic,ROC)分析显示,血浆miR-126表达水平可以区分ARDS患者和非ARDS患者,其曲线下面积(area under the ROC,AUC)为0.741(95%CI=0.666~0.815)。多元逻辑回归分析显示,miR-126高表达(P<0.001)是较高ARDS发病风险的独立预测因素。在总体脓毒症患者中,血浆miR-126表达量与血清肌酐(P=0.004)、C反应蛋白(P<0.001)、降钙素原(P<0.001)、急性生理功能和慢性健康状况II评分(P<0.001)、序贯器官衰竭(sequential organ failure assessment,SOFA)评分(P<0.001),以及炎性因子TNF-α(P=0.001)、IL-1β(P=0.002)、IL-6(P=0.011)和IL-17(P=0.002)水平均成正相关。此外,血浆miR-126在死亡患者中的表达量明显高于生存患者(P<0.001),ROC曲线分析显示其可以预测脓毒症患者较高的28 d死亡风险,AUC为0.686(95%CI=0.601~0.771)。结论:本研究表明,较高的循环miR-126表达量可以预测脓毒症患者中较高的ARDS发病率,并且可以作为辅助脓毒症疾病监测和患者预后的生物标志物。Objective:To assess the predictive role of plasma microRNA(miR)-126 on risk of acute respiratory distress syndrome(ARDS)in patients with sepsis,and to investigate the correlation of miR-126 and sepsis severity,inflammation level and prognosis.Methods:A total of 172 patients with sepsis were continuously enrolled.Peripheral blood samples of patients were collected within 24 hours after admission,and plasma was separated;expression level of miR-126 was detected by quantitive polymerase chain reaction.Expression levels of inflammatory cytokines[including tumor necrosis factor-α(TNF-α),interleukin(IL)-1β,IL-6 and IL-17)in plasma were detected by enzyme-linked immune sorbent assay(ELISA).Meanwhile,the 28-day mortality was recorded as well.Results:Among them,50 patients(30.8%)had ARDS during hospitalization,and plasma miR-126 expression was significantly elevated in ARDS patients when compared with non-ARDS patients(P<0.001).According to the receiver operating characteristic curve(ROC)analysis,expression level of plasma miR-126 was able to differentiate ARDS patients form non-ARDS patients,with area under the ROC(AUC)of 0.741(95%CI=0.666-0.815).In accordance with the multivariate logistic regression model analysis,high expression of miR-126(P<0.001)was the independent predictive factor for relative-high onset-risk of ARDS.In addition,of all sepsis patients,plasma miR-126 expression was positively correlated with levels of serum creatinine(P=0.004),C reactive protein(P<0.001),procalcitonin(P<0.001),acute physiology and chronic health evaluationⅡ(APACHEⅡ)score(P<0.001),sequential organ failure assessment(SOFA)score(P<0.001),and inflammatory factors of TNF-α(P=0.001),IL-1β(P=0.002),IL-6(P=0.011)and IL-17(P=0.002).Moreover,the expression level of plasma miR-126 in the dead was significantly higher than that in the survivors(P<0.001).According to the ROC curve analysis,it was able to predict that patients with sepsis had a high 28-day mortality risk,with AUC of 0.686(95%CI=0.601-0.771).Conclusion:Higher circulating

关 键 词：脓毒症 急性呼吸窘迫综合征 MIR-126 发病风险 疾病严重程度 

分 类 号：R631[医药卫生—外科学]