miR-21在脓毒症急性呼吸窘迫综合征中的表达及临床价值  

Expression and clinical value of miR-21 in septic acute respiratory distress syndrome

作　　者：周莹 吴爽 柯慧娟 陈琛[1] 李天民[1] Zhou Ying;Wu Shuang;Ke Huijuan;Chen Chen;Li Tianmin(Department of Intensive Care Unit,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院重症医学科,张家口075000

出　　处：《中华急诊医学杂志》2023年第9期1221-1225,共5页Chinese Journal of Emergency Medicine

基　　金：河北省卫健委科研项目(20200526)。

摘　　要：目的探讨血清微小RNA-21(miR-21)在脓毒症急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者中的表达水平,分析其与炎症因子的相关性及对临床预后的评估价值。方法采用前瞻性研究,选取2020年10月至2022年3月河北北方学院附属第一医院重症医学科收治的脓毒症患者作为研究对象,根据入院3 d内是否合并ARDS分为ARDS组和非ARDS组,根据氧合指数将ARDS组分为低危组和高危组,根据28 d生存情况将ARDS组分为存活组和死亡组。另选择同期体检的50例健康志愿者纳入对照组。比较各组入院时外周血miR-21表达水平和炎症因子[白细胞介素(interleukin,IL)-6和肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)]水平,分析血清miR-21表达与炎症因子关系,探究miR-21对预测脓毒症ARDS患者预后的评估价值。结果本研究106例脓毒症患者。与健康对照组相比,ARDS组、非ARDS组血清miR-21、TNF-α和IL-6水平均显著升高(均P<0.05);与低危组相比,高危组血清miR-21表达水平、TNF-α和IL-6水平均显著升高(均P<0.05);与生存组相比,死亡组血清miR-21表达水平、TNF-α和IL-6水平均显著升高(均P<0.05)。Pearson相关分析表明,ARDS组血清miR-21表达水平与IL-6和TNF-α水平呈正相关(r=0.842、0.697,P<0.001)。ROC曲线分析显示,血清miR-21预测脓毒症合并ARDS死亡的AUC=0.876(95%CI:0.761~0.942),最佳截断值为2.25,敏感度、特异度分别为92.9%和71.7%。结论血清miR-21表达水平在脓毒症ARDS患者中明显升高,和炎症因子水平呈正相关,并与疾病严重程度和预后密切相关,对脓毒症ARDS患者预后有较大的评估价值。Objective To investigate the expression level of miR-21 in patients with septic acute respiratory distress syndrome,and analyze its correlation with inflammatory factors and its value in evaluating clinical prognosis.Methods Patients with sepsis admitted to the intensive care unit(ICU)of the First Affiliated Hospital of Hebei North University from October 2020 to March 2022 were prospectively recruited.The patients were divided into an ARDS group and a non-ARDS group according to whether ARDS occurred within 3 days after admission.The ARDS group was divided into a low-risk group and a high-risk group according to the oxygenation index,and the ARDS group was divided into a survival group and a death group according to their 28-day survival status.In addition,50 healthy volunteers who underwent physical examination during the same period were included in the control group.The expression levels of serum miR-21 and inflammatory factors[tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)]were compared in each group at admission.To analyze the relationship between miR-21 expression and inflammatory factors and explore the value of miR-21 in predicting the prognosis of sepsis patients with ARDS.Results A total of 106 patients with sepsis were included.Compared with the healthy control group,the levels of serum miR-21,TNF-αand IL-6 in the ARDS group and non-ARDS group were significantly increased(all P<0.05).Compared with the low-risk group,the levels of serum miR-21,TNF-αand IL-6 in the high-risk group were significantly increased(all P<0.05).Compared with the survival group,the serum miR-21 expression level and TNF-αand IL-6 levels in the death group were significantly increased(all P<0.05).Pearson correlation analysis showed that the serum miR-21 expression level in the ARDS group was positively correlated with IL-6 and TNF-αlevels(r=0.842,0.697,P<0.001).ROC curve analysis showed that the AUC of serum miR-21 in predicting death from sepsis complicated with ARDS was 0.876(95%CI:0.761-0.942),the best cut-off val

关 键 词：微小核糖核酸-21 脓毒症 急性呼吸窘迫综合征 肿瘤坏死因子-α 白介素-6 预后评估 

分 类 号：R459.7[医药卫生—急诊医学] R563.8[医药卫生—治疗学]