血清miR-21-3p、IL-18水平检测对重症急性胰腺炎患者急性肾损伤预测评估的临床价值  

Evaluation value of serum miR-21-3p and IL-18 levels in the clinical prognosis of patients with severe acute pancreatitis with acute kidney injury

作　　者：宋云婷 徐翠萍 谭通 SONG Yun-ting;XU Cui-ping;TAN Tong(ICU,Qingdao Hospital of Traditional Chinese Medicine,Qingdao Shandong 266033,China)

机构地区：[1]青岛市中医医院(市海慈医院)重症医学科,山东青岛266033

出　　处：《临床和实验医学杂志》2024年第13期1385-1388,共4页Journal of Clinical and Experimental Medicine

基　　金：山东省卫健委科研计划项目(编号:2021FH286)。

摘　　要：目的探讨血清中微RNA(miR)-21-3p和白细胞介素(IL)-18水平对重症急性胰腺炎患者急性肾损伤(AKI)预测评估的临床价值。方法前瞻性选取2020年9月至2023年青岛市中医医院收治的146例急性重症胰腺炎患者,根据有无AKI分为AKI组(n=51)和非AKI组(n=95)。比较两组的临床资料[性别、年龄(≤50岁、>50岁)、病因类型(酒精性、胆源性、高血脂性、其他)、体重指数(≤28 kg/m 2、>28 kg/m 2)],比较两组血清中miR-21-3p(相对表达量、高表达比例、低表达比例)、IL-18水平(平均表达量、≤140 pg/mL比例、>140 pg/mL比例);采用Logistic回归模型分析影响重症急性胰腺炎患者住院期间AKI发生的因素;采用受试者操作特征(ROC)曲线分析miR-21-3p、IL-18对重症急性胰腺炎患者并发AKI的预测价值。结果AKI组患者的性别、年龄、病因类型、体重指数与非AKI组比较,差异均无统计学意义(P>0.05)。AKI组的miR-21-3p相对表达量、IL-18水平、Ranson评分分别为2.24±0.52、(178.21±49.32)pg/mL、(6.14±1.24)分,均明显高于非AKI组[1.58±0.35、(82.35±38.43)pg/mL、(4.53±1.12)分],差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,miR-21-3p和IL-18增高均是SAP患者发生AKI的危险因素(OR=1.490,95%CI:1.035~1.832;OR=1.421,95%CI:1.042~1.734;P<0.05)。miR-21-3p和IL-18联合检测对重症急性胰腺炎伴AKI的诊断具有更高的敏感性和特异性,AUC为0.873,敏感度为90.42%,特异度为91.24%。结论在重症急性胰腺炎合并AKI患者中,血清中miR-21-3p和IL-18水平显著升高。检测血清miR-21-3p和IL-18水平有助于预测重症急性胰腺炎合并AKI,尤其在联合检测时,有更高的准确性。Objective To investigate the clinical value of serum microRNA(miR)-21-3p and interleukin(IL)-18 levels in the prediction and evaluation of acute kidney injury(AKI)in patients with severe acute pancreatitis.Methods A total of 146 patients with severe acute pancreatitis admitted to Qingdao Hospital of Traditional Chinese Medicine from September 2020 to 2023 were prospectively selected,divided into the AKI group(n=51)and the non-AKI group(n=95)according to whether they had AKI or not.The clinical data[gender,age(≤50 years,>50 years),etiology type(alcoholic,biliary,hyperlipidemic,other),body mass index(≤28 kg/m 2,>28 kg/m 2)],the serum miR-21-3p(relative expression,high expression ratio,low expression ratio)and IL-18 levels(average expression,≤140 pg/mL ratio,>140 pg/mL ratio)of the two groups were compared.The factors affecting the occurrence of AKI during hospitalization in patients with severe acute pancreatitis were analyzed using a Logistic regression model.The predictive value of miR-21-3p and IL-18 for AKI in patients with severe acute pancreatitis was analyzed using receiver operating characteristic(ROC)curves.Results There were no statistically significant differences in gender,age,etiology,and body mass index between the AKI group and the non-AKI group(P>0.05);the relative expression of miR-21-3p,IL-18 level and Ranson score in the AKI group were 2.24±0.52,(178.21±49.32)pg/mL and(6.14±1.24)points,respectively,which were significantly higher than those in the non-AKI group[1.58±0.35,(82.35±38.43)pg/mL and(4.53±1.12)points],the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that increased miR-21-3p and IL-18 were risk factors for AKI in severe acute pancreatitis patients(OR=1.490,95%CI:1.035-1.832;OR=1.421,95%CI:1.042-1.734;P<0.05).Combined detection of miR-21-3p and IL-18 had higher sensitivity and specificity for the diagnosis of severe acute pancreatitis with AKI,with an AUC of 0.873,a sensitivity of 90.42%,and a specificity of 91.24%.Conclus

关 键 词：重症急性胰腺炎 急性肾损伤 miR-21-3p 白细胞介素-18 

分 类 号：R576[医药卫生—消化系统] R446.1[医药卫生—内科学]