肝硬化食管胃底静脉曲张破裂出血患者血清miR⁃9a⁃5p表达水平与再出血的关系  

Relationship between the expression level of serum miR⁃9a⁃5p and rebleeding in the patients with ruptured and bleeding of esophageal and gastric varices in liver cirrhosis

作　　者：邓念菊 吴丽玲[1] 叶小苗 邝继孙[1] Deng Nianju;Wu Liling;Ye Xiaomiao;Kuang Jisun(Endoscopy Center,Hainan People’s Hospital(Hainan Hospital Affiliated to Hainan Medical College),Haikou 570311,China)

机构地区：[1]海南省人民医院(海南医学院附属海南医院)内镜中心,海南海口570311

出　　处：《海军医学杂志》2022年第4期389-394,共6页Journal of Navy Medicine

基　　金：海南省自然科学基金(ZDXM20130071)。

摘　　要：目的探究血清微小核糖核酸‐9a‐5p(microRNA‐9a‐5p,miR‐9a‐5p)表达水平与肝硬化食管胃底静脉曲张破裂出血患者治疗后发生再出血的关系。方法选取2018年2月至2019年3月在海南省人民医院就诊的189例肝硬化食管胃底静脉曲张破裂出血患者作为观察组,根据是否发生再出血分为未再出血组(n=125)和再出血组(n=64)2个亚组。另选取50例不伴食管胃底静脉曲张的肝硬化患者作为对照组。采用实时荧光定量PCR法检测血清miR‐9a‐5p表达水平,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)评价血清miR‐9a‐5p表达水平判断再出血的价值,以及采用Logistic回归分析血清miR‐9a‐5p表达水平与肝硬化食管胃底静脉曲张破裂出血后再出血的关系。结果观察组患者治疗前、后血清miR‐9a‐5p表达水平均高于对照组,差异均有统计学意义(P<0.05)。亚组中未再出血组和再出血组患者治疗后的血清miR‐9a‐5p相对表达水平均低于治疗前,未再出血组患者治疗前的血清miR‐9a‐5p相对表达水平低于再出血组,差异均有统计学意义(P<0.05)。患者治疗前的血清miR‐9a‐5p表达水平预判再出血的曲线下面积高于治疗后,差异有统计学意义(P<0.05)。再出血组的白蛋白、血钠和血钙水平均低于未再出血组,而Child‐Pugh C级占比、门静脉内径、重度食管静脉曲张占比和红色征占比高于未再出血组,差异均有统计学意义(P<0.05)。Child‐Pugh C级、门静脉内径>1.30 cm、重度食管静脉曲张、红色征和治疗前的血清miR‐9a‐5p表达水平>1.89是肝硬化食管胃底静脉曲张破裂出血后再出血的独立危险因素(P<0.05),而血钠>136.67 mmol/L是肝硬化食管胃底静脉曲张破裂出血后再出血的独立保护因素(P<0.05)。结论治疗前的血清miR‐9a‐5p表达水平与肝硬化食管胃底静脉曲张破裂出血后再出血有关。Objective To investigate the relationship between the expression level of serum miR‐9a‐5p and rebleeding after the patients with ruptured and bleeding of esophageal and gastric varices in liver cirrhosis.Methods A total of 189 patients with esophageal and gastric varices bleeding from cirrhosis who were admitted to Hainan General Hospital from February 2018 to March 2019 were selected as research subjects(the observation group).Depending on whether or not rebleeding occurred,they were further divided into two groups:the no rebleeding group(n=125)and the rebleeding group(n=64).Another 50 patients with liver cirrhosis without esophageal gastric varices were recruited as the control group.The expression level of serum miR‐9a‐5p was detected by real‐time fluorescence quantitative PCR.Receiver operating characteristic(ROC)was used to evaluate the value of the expression level of serum miR‐9a‐5p in predicting rebleeding.Logistic regression was used to analyze the relationship between serum miR‐9a‐5p expression level and rebleeding of esophageal and gastric varices bleeding from cirrhosis.Results The expression levels of serum miR‐9a‐5p in the observation group before and after treatment were higher than those in the control group,with statistical significance(P<0.05).After treatment,related expression levels of serum miR‐9a‐5p in both the non‐rebleeding group and the rebleeding group were lower than those before treatment,and the expression level of serum miR‐9a‐5p in the non‐rebleeding group before treatment was lower than that in the rebleeding group,also with statistical significance(P<0.05).The area under the ROC of serum miR‐9a‐5p before treatment was higher than that after treatment,with statistical significance also(P<0.05).The levels of albumin,blood sodium and calcium in the rebleeding group were lower than those in the non‐rebleeding group.The proportion of Child‐Pugh grade C,portal vein internal diameter,the proportion of severe esophageal varices prevalence and red

关 键 词：肝硬化 食管胃底静脉曲张破裂出血 微小核糖核酸‐9a‐5p 再出血 

分 类 号：R5713[医药卫生—消化系统] R575.2[医药卫生—内科学]