血清miR-146b、ICAM-1与急性呼吸窘迫综合征患者疾病严重程度、预后的关系  

Relation of serum miR-146b,ICAM-1 with the severity and prognosis of patients with acute respiratory distress syndrome

作　　者：郦文捷 潘永良[2] 黄晓敏 顾俊[1] LI Wenjie;PAN Yongliang;HUANG Xiaomin;GU Jun(Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Nantong University,Medical School of Nantong University,Nantong 226001,Jiangsu,China;Department of Geriatrics,Danyang Hospital Affiliated to Nantong University,Danyang 212300,Jiangsu,China)

机构地区：[1]南通大学附属医院呼吸与危重症医学科、南通大学医学院,江苏省南通市226001 [2]南通大学附属丹阳医院老年科,江苏省丹阳市212300

出　　处：《广西医学》2023年第10期1137-1142,1152,共7页Guangxi Medical Journal

基　　金：江苏省自然科学基金(BK20181032)。

摘　　要：目的探讨血清miR-146b、细胞间黏附分子1(ICAM-1)与急性呼吸窘迫综合征(ARDS)患者疾病严重程度、预后的关系。方法收集186例ARDS患者的基线资料、生化指标[氧合指数、血管外肺水指数(EVLWI)、血清肿瘤坏死因子α(TNF-α)水平、白细胞介素(IL)-6水平、IL-10水平]和血清miR-146b、ICAM-1水平。根据疾病严重程度将患者分为轻度组(n=45)、中度组(n=58)、重度组(n=83),并根据治疗28 d后的预后情况将患者分为死亡组(n=52)和存活组(n=134)。比较不同分组患者的上述指标。采用Pearson相关分析法分析186例ARDS患者血清miR-146b、ICAM-1水平与氧合指数和炎症因子水平的相关性。采用多因素Logistic回归模型分析ARDS患者预后不良的影响因素。利用受试者工作特征(ROC)曲线分析血清miR-146b、ICAM-1水平对ARDS患者预后不良的预测价值。结果轻度组、中度组、重度组患者的血清miR-146b、IL-10水平依次降低,血清ICAM-1、TNF-α、IL-6水平依次升高(均P<0.05)。ARDS患者血清miR-146b水平与氧合指数、血清IL-10水平呈正相关,与血清ICAM-1、TNF-α、IL-6水平呈负相关(均P<0.05),血清ICAM-1水平与氧合指数、血清IL-10水平呈负相关,与血清TNF-α、IL-6水平呈正相关(均P<0.05)。与存活组比较,死亡组患者的机械通气时间、急诊ICU入住时间延长,氧合指数和血清miR-146b、IL-10水平降低,EVLWI和血清TNF-α、IL-6、ICAM-1水平升高(均P<0.05)。机械通气时间延长、EVLWI和血清TNF-α、IL-6、ICAM-1水平升高是ARDS患者预后不良的独立危险因素,氧合指数和血清IL-10、miR-146b水平升高是其独立保护因素(均P<0.05)。血清miR-146b、ICAM-1水平预测ARDS患者预后不良的曲线下面积分别为0.802、0.811。结论miR-146b、ICAM-1可能通过调控炎症反应参与ARDS的发生和发展,与ARDS患者的疾病严重程度和预后有关,可作为患者预后不良的预测指标。Objective To investigate the relation of serum miR-146b,intercellular adhesion molecule 1(ICAM-1)with the severity and prognosis of patients with acute respiratory distress syndrome(ARDS).Methods The baseline data,biochemical indices with respect to oxygenation index,extravascular lung water index(EVLWI),serum tumor necrosis factorα(TNF-α)level,interleukin(IL)-6 level,IL-10 level,and serum miR-146b and ICAM-1 levels of 186 patients with ARDS were collected.Patients were divided into mild group(n=45),moderate group(n=58)or severe group(n=83)according to the severity of disease,and they were assigned to death group(n=52)or survival group(n=134)according to the prognosis after 28 days of treatment.The aforementioned indices were compared between patients in different groups.The Pearson correlation analysis method was used to analyze the correlation of levels of serum miR-146b and ICAM-1 with oxygenation index and inflammatory factors levels in 186 patients with ARDS.The multivariate Logistic regression model was employed to analyze the influencing factors for adverse prognosis in ARDS patients.The predictive value of serum miR-146b and ICAM-1 levels on adverse prognosis of ARDS patients was analyzed by using the receiver operating characteristic(ROC)curve.Results The levels of serum miR-146b and IL-10 in the mild group,the moderate group,and the severe group were decreased successively,while the levels of serum ICAM-1,TNF-α,and IL-6 were increased successively(all P<0.05).ARDS patients′serum miR-146b level positively correlated with oxygenation index and serum IL-10 level,whereas negatively correlated with serum ICAM-1,TNF-α,and IL-6 levels(all P<0.05).ARDS patients′serum ICAM-1 level negatively correlated with oxygenation index and serum IL-10 level,while positively correlated with serum TNF-αand IL-6 levels(all P<0.05).Compared with the survival group,prolonged duration of mechanical ventilation,prolonged length of emergency ICU stay,a decreased oxygenation index,and decreased serum miR-146b and IL-10 lev

关 键 词：急性呼吸窘迫综合征 微小RNA-146b 细胞间黏附分子1 预后 预测 

分 类 号：R563.8[医药卫生—呼吸系统]