血清miR-320表达水平对脓毒症并发急性肾损伤患儿预后的预测价值  

The value of serum miR-320 expression in predicting the prognosis of sepsis children complicated with acute kidney injury

作　　者：张素丽 林秋玉 张娅琴 杨辉 王铭 Zhang Suli;Lin Qiuyu;Zhang Yaqin;Yang Hui;Wang Ming(Department of Pediatrics,Hainan Women and Children′s Medical Center,Haikou 570000,China)

机构地区：[1]海南省妇女儿童医学中心儿科,海口570000

出　　处：《中华实用儿科临床杂志》2021年第17期1328-1332,共5页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨血清miR-320表达水平对脓毒症并发急性肾损伤(AKI)患儿预后的预测价值。方法选取2017年1月至2019年6月海南省妇女儿童医学中心收治的脓毒症并发AKI患儿158例,根据其28 d的生存情况分为生存组(105例)和死亡组(53例),检测两组血清miR-320、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子-1(KIM-1)及血肌酐(Scr)水平。应用多因素Logistic回归分析脓毒症并发AKI患儿发生死亡的危险因素。绘制受试者工作特征曲线(ROC)分析血清miR-320、NGAL、KIM-1及Scr水平预测脓毒症并发AKI患儿死亡的价值,Pearson相关分析血清miR-320表达水平与NGAL、KIM-1及Scr的相关性。结果死亡组血清miR-320(1.28±0.47比0.54±0.12)、NGAL[(537.40±48.26)mg/L比(285.60±29.40)mg/L]、KIM-1[(26.80±5.72)μg/L比(16.35±3.17)μg/L]及Scr[(573.70±105.46)μmol/L比(390.64±74.38)μmol/L]水平明显高于生存组,差异均有统计学意义(均P<0.001)。多因素Logistic回归分析,发现血清miR-320(OR=2.280,95%CI:1.483~4.380)、NGAL(OR=2.753,95%CI:1.826~5.227)、KIM-1(OR=1.985,95%CI:1.274~3.518)及Scr(OR=1.714,95%CI:1.105~2.986)水平升高是脓毒症并发AKI患儿发生死亡的独立危险因素(均P<0.001)。ROC曲线分析显示,血清miR-320、NGAL、KIM-1及Scr水平4项联合预测脓毒症并发AKI患儿死亡的曲线下面积(0.952,95%CI:0.894~0.990)最大,其敏感度和特异度较高(95.8%和90.6%)。相关分析显示,死亡组血清miR-320表达水平与NGAL、KIM-1及Scr均呈正相关(r=0.874、0.830、0.702,均P<0.01)。结论血清miR-320表达水平在脓毒症并发AKI患儿中明显升高,是脓毒症并发AKI患儿发生死亡的独立危险因素,联合NGAL、KIM-1及Scr水平对患儿预后预测具有重要的价值。Objective To investigate the prognostic value of serum levels of miR-320 in sepsis children complicated with acute kidney injury(AKI).Methods A total of 158 sepsis children with complicated with AKI who were admitted to Hainan Women and Children′s Medical Center from January 2017 to June 2019 were divided into survival group(105 cases)and death group(53 cases)according to their 28-day survival.Serum levels of miR-320,neutrophil gelatinase associated lipocalin(NGAL),kidney injury molecule-1(KIM-1)and serum creatinine(Scr)were detected in the two groups.Multivariate Logistic regression was used to analyze the risk factors of death in children with sepsis complicated with AKI.The receiver operating characteristic curve(ROC)was drawn to analyze the value of serum levels of miR-320,NGAL,KIM-1 and Scr in predicting the death of children with sepsis complicated with AKI.The correlation between serum levels of miR-320 and NGAL,KIM-1 and Scr was analyzed using Pearson correlation analysis.Results The serum levels of miR-320(1.28±0.47 vs.0.54±0.12),NGAL[(537.40±48.26)mg/L vs.(285.60±29.40)mg/L],KIM-1[(26.80±5.72)μg/L vs.(16.35±3.17)μg/L]and Scr[(573.70±105.46)μmol/L vs.(390.64±74.38)μmol/L]in the death group were significantly higher than those in the survival group(all P<0.001).Multivariate Logistic regression analysis showed that serum levels of miR-320(OR=2.280,95%CI:1.483-4.380),NGAL(OR=2.753,95%CI:1.826-5.227),KIM-1(OR=1.985,95%CI:1.274-3.518)and Scr(OR=1.714,95%CI:1.105-2.986)were independent risk factors for death in sepsis children with AKI(all P<0.001).ROC curve analysis showed that the area under the curve(0.952,95%CI:0.894-0.990)of serum miR-320,NGAL,KIM-1 and Scr levels combined to predict the death of children with sepsis and AKI was the largest,with a high sensitivity and specificity of 95.8%and 90.6%.Correlation analysis showed that the expression level of serum miR-320 in the death group was positively correlated with NGAL,KIM-1 and Scr(r=0.874,0.830,0.702,all P<0.01).Conclusions Serum levels

关 键 词：脓毒症 急性肾损伤 儿童 miR-320 预后预测 

分 类 号：R720.597[医药卫生—急诊医学] R726.9[医药卫生—儿科]