肝硬化食管胃底静脉曲张破裂出血患者miR-183-5p水平与经颈静脉肝内门腔静脉分流术后再出血的关系  

Association between microRNA-183-5p levels and rebleeding after TIPS in cirrhosis patients with esophageal and gastric variceal bleeding

作　　者：赵永昌[1] 徐菁 陈士新[1] 崔涛涛[3] Yong-chang Zhao;Jing Xu;Shi-xin Chen;Tao-tao Cui(Department of Interventional Radiology,The 3201 Hospital Affiliated to Xi'an Jiaotong University Health Science Center,Hanzhong,Xi'an 723000,China;Department of Gastroenterology,The 3201 Hospital Affiliated to Xi'an Jiaotong University Health Science Center,Hanzhong,Xi'an 723000,China;Department of CT Diagnostics,Affiliated Hospital of Yan'an University,Yan'an,Xi'an 716099,China)

机构地区：[1]西安交通大学医学院附属三二〇一医院影像科介入室,陕西汉中723000 [2]西安交通大学医学院附属三二〇一医院消化内科,陕西汉中723000 [3]延安大学附属医院CT诊断科,陕西延安716099

出　　处：《中国现代医学杂志》2022年第16期62-68,共7页China Journal of Modern Medicine

基　　金：陕西省重点研发计划项目(No:2021SF-244)。

摘　　要：目的探究肝硬化食管胃底静脉曲张破裂出血患者microRNA-183-5p(miR-183-5p)水平与经颈静脉肝内门腔静脉分流术(TIPS)后再出血的关系。方法前瞻性选取2017年2月—2020年10月在西安交通大学医学院附属三二〇一医院接受TIPS治疗的食管胃底静脉曲张破裂出血患者178例作为研究对象。根据随访过程中是否再出血将患者分为再出血组和未再出血组。采用实时荧光定量聚合酶链反应检测患者TIPS前(T_(1))、TIPS后24 h(T_(2))和TIPS后7 d(T_(3))的miR-183-5p水平。随访患者TIPS后再出血情况,分析miR-183-5p与TIPS后再出血的关系。结果两组患者性别、年龄、肝硬化病因、Child-Pugh分级、血小板计数、凝血酶原时间和国际标准化比率比较,差异均无统计学意义(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(P<0.05),门静脉内径大于未再出血组,重度食管静脉曲张占比高于未再出血组(P<0.05)。两组患者T_(1)、T_(2)、T_(3)的miR-183-5p水平比较,经重复测量设计的方差分析,结果:①不同时间点miR-183-5p有差异(P<0.05);②两组患者miR-183-5p有差异(P<0.05);③两组患者miR-183-5p变化趋势有差异(P<0.05)。T_(1)-miR-183-5p的曲线下面积和敏感性最高,分别为0.827(95%CI:0.768,0.886)和74.55%(95%CI:61.00,85.30),T_(3)时miR-183-5p的特异性最高,为88.62%(95%CI:81.60,93.60)。一般多因素Logistic回归分析结果显示:血钠>136.62 mmoL/L[OR=0.177(95%CI:0.073,0.429)]、血钙>2.07 mmoL/L[OR=0.386(95%CI:0.160,0.928)]和T_(1)时miR-183-5p>1.19[OR=0.079(95%CI:0.029,0.216)]是肝硬化食管胃底静脉曲张破裂出血患者TIPS后发生再出血的保护因素(P<0.05),门静脉内径>1.30 cm[OR=3.094(95%CI:1.290,7.421)]和重度食管静脉曲张[OR=8.342(95%CI:2.086,33.367)]是肝硬化食管胃底静脉曲张破裂出血患者TIPS后发生再出血的危险因素(P<0.05)。模型A的C-index为0.771,模型B的C-index为0.867。模型A的平均绝对误差值为0.0Objective To investigate the relationship between microRNA-183-5p(miR-183-5p)levels and rebleeding after transjugular intrahepatic portosystemic shunt(TIPS)in cirrhosis patients with esophageal and gastric variceal bleeding.Methods A total of 178 cirrhosis patients with esophageal and gastric variceal bleeding treated with TIPS in the 3201 Hospital Affiliated to Xi’an Jiaotong University Health Science Center from February 2017 to October 2020 were prospectively selected.The patients were then divided into rebleeding group and non-rebleeding group.The levels of miR-183-5p prior to TIPS(T_(1)),24 h after TIPS(T_(2))and 7 days after TIPS(T_(3))were measured by quantitative real-time polymerase chain reaction(qRT-PCR).The occurrence of rebleeding after TIPS was followed up and the relationship between miR-183-5p and the occurrence of rebleeding after TIPS was analyzed.Results There was no difference in the gender,age,the cause of cirrhosis,the distribution of Child-Pugh classification,the platelet count,prothrombin time,and the international normalized ratio between the two groups.The levels of albumin,blood sodium and blood calcium in the rebleeding group were lower than those in the non rebleeding group(P<0.05).The inner diameter of portal veins and the frequency of severe esophageal varices in the rebleeding group were higher than those in the non-rebleeding group(P<0.05).The levels of miR-183-5p at T_(1),T_(2),and T_(3) were compared between the two groups,and the repeated-measures analysis of variance demonstrated that the levels of miR-183-5p were different among the time points(P<0.05)and between the groups(P<0.05).The change trends of miR-183-5p levels were also different between the two groups(P<0.05).The area under the receiver operating characteristic(ROC)curve[0.827(95%CI:0.768,0.886)]and the sensitivity[74.55%(95%CI:61.00,85.30)]of the miR-183-5p level at T_(1),and the specificity of the miR-183-5p level at T_(3)[88.62%(95%CI:81.60,93.60)],were the highest for determining the occurrence of rebleeding

关 键 词：肝硬化 食管胃底静脉曲张破裂出血 微小核糖核酸-183-5p 经颈静脉肝内门腔静脉分流术 

分 类 号：R657.31[医药卫生—外科学]