急性坏死性胰腺炎感染病情程度及预后与miR-25和TRAIL的关联  

Association of the degree of disease and prognosis of patients with acute necrotizing pancreatitis infection with miR-25 and TRAIL

作　　者：滕旭升 孔来法 陈琳 丁颖威 TENG Xu-sheng;KONG Lai-fa;CHEN Lin;DING Ying-wei(Jinhua Central Hospital,Jinhua,Zhejiang 321000,China)

机构地区：[1]金华市中心医院急诊科,浙江金华321000

出　　处：《中华医院感染学杂志》2024年第20期3053-3057,共5页Chinese Journal of Nosocomiology

基　　金：浙江省卫生健康科技计划基金资助项目(2022PY099)。

摘　　要：目的探讨急性坏死性胰腺炎(ANP)感染患者病情程度及预后与外周血微小RNA-25(miR-25)、肿瘤坏死因子相关凋亡诱导配体(TRAIL)的关联。方法选取2020年1月-2023年3月金华市中心医院收治的83例ANP感染患者,按病情程度分为轻度组24例、中度组31例和重度组28例,根据随访28 d生存情况分为预后良好组61例和预后不良组22例;无菌收集患者胰腺坏死组织或引流标本,进行病原菌分离鉴定;比较不同病情程度ANP感染患者外周血miR-25、TRAIL、肿瘤坏死因子-α(TNF-α)水平和急性生理与慢性健康Ⅱ(APACHEⅡ)评分;采用Pearson相关性分析不同病情程度ANP感染患者外周血miR-25、TRAIL、TNF-α水平和APACHEⅡ评分的关系;比较预后不良组和预后良好组临床特征及外周血miR-25、TRAIL、TNF-α水平;采用受试者工作特征(ROC)曲线分析外周血miR-25表达水平对ANP患者预后的评估价值。结果ANP感染患者检出病原菌98株,以大肠埃希菌、肺炎克雷伯菌和屎肠球菌为主;重度组ANP感染患者外周血miR-25、TRAIL为(0.21±0.05)、(49.31±12.78)pg/ml低于中度组和轻度组,TNF-α和APACHEⅡ分别为(36.49±6.02)pg/ml和(24.15±6.79)分高于中度组和轻度组(P<0.05);ANP感染患者外周血miR-25、TRAIL与APACHEⅡ评分呈负相关(r=-0.587,-0.548,P均<0.05),TNF-α水平与APACHEⅡ评分呈正相关(r=0.506,P<0.001);预后不良组外周血miR-25、TRAIL分别为(0.23±0.09)、(55.17±4.26)pg/ml低于预后良好组,TNF-α为(36.79±6.44)pg/ml高于预后良好组(P<0.05);miR-25预测ANP患者不良预后的曲线下面积(AUC)为0.837,截断值为0.24(P<0.05)。结论ANP感染患者外周血miR-25、TRAIL水平与疾病程度呈负相关,外周血miR-25检测可作为ANP感染患者预后评估的可靠指标。OBJECTIVE To explore the association of the degree of disease and prognosis of patients with acute necrotizing pancreatitis(ANP)infection with peripheral blood microRNA-25(miR-25)and tumor necrosis factor-related apoptosis-inducing ligand(TRAIL).METHODS A total of 83 patients with ANP infection admitted to Jinhua Central Hospital between Jan.2020 and Mar.2023 were selected and were divided into mild group(24 cases),moderate group(31 cases)and severe group(28 cases)according to disease severity,and they were further divided into good prognosis group(61 cases)and poor prognosis group(22 cases)according to survival status within 28d of follow-up.The pancreatic necrosis tissues or drainage specimens were collected aseptically for isolation and identification of pathogens.The levels of peripheral blood miR-25,TRAIL and tumor necrosis factor-α(TNF-α),and scores of acute physiology and chronic health evaluation Ⅱ(APACHEII)in patients with different disease severity were compared.The relationship between serum miR-25,TRAIL,TNF-αand APACHE Ⅱ scores was analyzed by Pearson correlation analysis.The clinical characteristics,levels of peripheral blood miR-25,TRAIL and TNF-α were compared between poor prognosis group and good prognosis group.The evaluation value of peripheral blood miR-25 in assessing the prognosis of patients with ANP comorbidities was analyzed by receiver operating characteristic(ROC)curves.RESULTS There were 98 strains of pathogens in patients with ANP infection,which were mainly of Escherichia coli,Klebsiella pneumoniae and Enterococcus faecium.The levels of peripheral blood miR-25 and TRAIL in severe groups were(0.21±0.05)and(49.31±12.78)pg/ml,lower than those in moderate group and mild group,while TNF-α level and APACHE Ⅱ score were(36.49±6.02)pg/ml and(24.15±6.79)points,respectively higher than those in moderate group and mild group(P<0.05).The levels of miR-25 and TRAIL were negative correlated with APACHE Ⅱ scores(r=-0.587,-0.548,P all<0.05),while TNF-α was positively correlated with

关 键 词：急性坏死性胰腺炎 感染 微小RNA-25 肿瘤坏死因子相关凋亡诱导配体 疾病程度 预后 相关性 预测价值 

分 类 号：R576[医药卫生—消化系统]