脓毒症并发急性肾损伤患儿血清中miR-93-5p和miR-424-5p的表达及临床意义  

Expression and clinical significance of miR-93-5p and miR-424-5p in serum of children with sepsis complicated by acute kidney injury.

作　　者：马静[1] 郑喜胜[1] 李长力[1] 赵聪源 MA Jing;ZHENG Xi-sheng;LI Chang-li;ZHAO Cong-yuan(Comprehensive ICU,Nanyang Central Hospital,Nanyang 473000,Henan,CHINA)

机构地区：[1]南阳市中心医院综合ICU,河南南阳473000

出　　处：《海南医学》2024年第4期531-536,共6页Hainan Medical Journal

基　　金：河南省南阳市医学科技攻关项目(编号:KJGG087)。

摘　　要：目的探讨血清中微小RNA-93-5p(miR-93-5p)和微小RNA-424-5p(miR-424-5p)在脓毒症并发急性肾损伤(S-AKI)患儿中的表达水平及其临床意义。方法选取2019年11月至2021年11月南阳市中心医院综合ICU收治的116例脓毒症患儿作为研究对象,根据脓毒症患儿是否并发AKI分为AKI组60例和非AKI组56例;比较两组患儿的一般资料和血清miR-93-5p、miR-424-5p及肾功能指标[血肌酐(Scr)、胱抑素C(Cys-C)]水平;采用Pearson法分析S-AKI患儿血清miR-93-5p、miR-424-5p与肾功能指标的相关性;采用多因素Logistic回归分析脓毒症患儿并发AKI的影响因素;采用受试者工作特征曲线(ROC)分析血清miR-93-5p、miR-424-5p水平对脓毒症患儿并发AKI的诊断价值。结果AKI组患儿的尿量为(1.52±0.31)mL·kg^(-1)·h^(-1)、血清miR-93-5p表达水平为0.62±0.14,均明显低于非AKI组的(1.87±0.36)mL·kg^(-1)·h^(-1)、(1.02±0.21),急性生理学与慢性健康状况评分(APACHEⅡ评分)、序贯器官衰竭评分(SOFA评分)、血清miR-424-5p表达水平、Scr、Cys-C水平分别为(17.35±5.01)分、(5.77±1.80)分、(2.36±0.51)、(182.84±43.31)μmol/L、(1.63±0.39)mg/L,明显高于非AKI组的(14.96±4.12)分、(5.10±1.41)分、(1.01±0.23)、(91.51±28.34)μmol/L、(0.96±0.28)mg/L,差异均有统计学意义(P<0.05);经Pearson法分析结果显示,S-AKI患儿血清miR-93-5p与Scr、Cys-C呈负相关(r=-0.621、-0.720,P<0.05),miR-424-5p与Scr、Cys-C呈正相关(r=0.503、0.538,P<0.05);经多因素Logistic回归分析结果显示,miR-424-5p、Scr、Cys-C是影响脓毒症患儿并发AKI的危险因素,miR-93-5p是保护因素(P<0.05);经ROC分析结果显示,血清miR-93-5p、miR-424-5p以及两者联合诊断脓毒血症患儿并发AKI的AUC分别为0.856、0.860、0.949,联合诊断的敏感度为90.00%,特异性为91.07%,两者联合优于血清miR-93-5p、miR-424-5p各自单独诊断(Z两者联合-miR-93-5p=2.897、Z两者联合-miR-424-5p=2.706,P=0.004、P=0.007)。结论S-AKI患儿血清miR-93-5Objective To investigate the expression and clinical significance of microRNA-93-5p(miR-93-5p)and microRNA-424-5p(miR-424-5p)in serum of children with sepsis complicated by acute kidney injury(S-AKI).Methods A total of 116 children with sepsis admitted to Comprehensive ICU of Nanyang Central Hospital from November 2019 to November 2021 were collected as the study subjects.The children were grouped into an AKI group of 60 cases and a non-AKI group of 56 cases based on whether they were complicated with AKI.The levels of serum miR-93-5p,miR-424-5p,and renal function indicators such as serum creatinine(Scr)and cystatin C(Cys-C)were detected in both groups.Pearson method was applied to analyze the correlation between serum miR-93-5p,miR-424-5p and renal function indicators in children with S-AKI.Multivariate logistic regression was applied to analyze the influencing factors of AKI in children with sepsis.ROC curve was applied to analyze the diagnostic value of serum miR-93-5p and miR-424-5p levels for sepsis complicated with AKI in children.Results The urine volume of children in AKI group was(1.52±0.31)mL·kg^(-1)·h^(-1),and the expression level of serum miR-93-5p was 0.62±0.14,which were significantly lower than(1.87±0.36)mL·kg^(-1)·h^(-1),1.02±0.21 in non-AKI group(P<0.05).The Acute Physiology and Chronic Health Evaluation(APACHEⅡ)score,sequential organ failure score(SOFA)score,serum miR-424-5p level,Scr level,and Cys-C level were(17.35±5.01)points,(5.77±1.80)points,2.36±0.51,(182.84±43.31)μmol/L,(1.63±0.39)mg/L,significantly higher than(14.96±4.12)points,(5.10±1.41)points,1.01±0.23,(91.51±28.34)μmol/L,(0.96±0.28)mg/L in the non-AKI group(P<0.05).Serum miR-93-5p was negatively correlated with Scr and Cys-C in children with S-AKI(r=-0.621,-0.720,P<0.05),while miR-424-5p was positively correlated with Scr and Cys-C(r=0.503,0.538,P<0.05).miR-424-5p,Scr,and Cys-C were risk factors for AKI in children with sepsis,while miR-93-5p was a protective factor(P<0.05).AUC of serum miR-93-5p,miR-424-5p,and

关 键 词：脓毒症 急性肾损伤 微小RNA-93-5p 微小RNA-424-5p 临床意义 

分 类 号：R726.1[医药卫生—儿科]