脓毒症患者血清miRNA-21和PCT动态表达及其临床意义

Dynamic expression of serum miRNA-21 and PCT in patients with sepsis and its clinical significance

摘要:

目的：观察血清miRNA-21和炎症因子PCT在脓毒症病程中的动态表达，并探讨与脓毒症病情以及预后的关系。方法：收集脓毒症患者58例、健康对照24例，其中一般脓毒症32例，脓毒性休克26例，按28 d病死率分为生存组48例和死亡组10例。检测研究对象在入组第1、3、5天血清miRNA-21表达量以及炎症因子PCT水平，并记录患者的临床信息。结果：①与健康对照组比较，脓毒症患者入组第1天血清miRNA-21表达量明显升高（Z=-7.061，P=0.000），做ROC曲线分析得出血清miRNA-21诊断脓毒症的曲线下面积为0.997（95%CI=0.991~1.000，P=0.000），且以miRNA-21≥ 0.875为截断点，其诊断脓毒症的特异度和灵敏度分别为91.7%、100%。②在脓毒症5 d病程中，不同时间点的miRNA-21表达差异具有统计学意义（F=67.778，P=0.000），且不同时间点两两比较均有统计学差异（P=0.000，P=0.000，P=0.000），入组第1天血清miRNA-21表达量（1.974±0.886） ng/μL高于第3天miRNA-21表达量（1.015±0.709） ng/μL，第3天血清miRNA-21表达量高于第5天miRNA-21表达量（0.531±0.312） ng/μL。③在脓毒症5 d病程中，不同时间点的PCT表达差异具有统计学意义（F=34.304，P=0.000），且不同时间点两两比较均有统计学差异（P=0.000，P=0.000，P=0.000），入组第1天PCT表达量（14.164±13.939） μg/L高于第3天PCT表达量（4.224±4.039） μg/L，第3天PCT表达量高于第5天PCT表达量（1.614±3.438） μg/L。④脓毒性休克组入组第1天，血清miRNA-21表达量、PCT水平及APACHEⅡ评分均高于一般脓毒症组（Z=-6.510，P=0.000；Z=-4.457，P=0.000；Z=-6.517，P=0.000），且miRNA-21表达量与APACHEⅡ评分成正相关（r=0.993，P=0.000）。⑤血清miRNA-21在死亡组中高表达，且在各个观测时间点两组表达量均具有统计学差异（Z=-2.823，P=0.005；Z=-3.664，P=0.000；Z=-4.942，P=0.000）。结论：血清miRNA-21在脓毒症中表达明显升高，可能为脓毒症潜在的早期诊断标记物。血清miRNA-21在脓毒症病程中的动态表达可能与机体炎症反应紧密相关，并在预警脓毒症严重程度以及评估预后方面具有积极的临床意义。

Abstract:

Objective：to investigate the dynamic expression of serum miRNA-21and inflammatory cytokine PCT in the course of sepsis，and to investigate its relationships with the severity and prognosis of sepsis. Methods：A total of 58 patients with sepsis and 24 healthy controls were collected，including 32 cases of general sepsis and 26 cases of septic shock.All patients with sepsis were divided into the survival group（n=48） and the death group（n=10） by the 28 day mortality rate. Serum miRNA-21 expressions and PCT were de－tected on 1，3，5 days after admission，and the basic clinical information was recorded. Results：①Compared with those of healthy controls，the serum miRNA-21 level of 1 day after admission in patients with sepsis was significantly higher（Z=-7.061，P=0.000），and the expression of miRNA-21of 1 day was valuable in sepsis diagnosis by ROC curve（area under the curve=0.997，95%CI=0.991 to 1.000，P=0.000）.Serum miRNA-21 more than 0.875 was taken as the cut-off point in the diagnosis of sepsis，and the sensitivity and specificity were 100% and 91.7%. ②In sepsis 5 d course，dif－ferent time points of miRNA-21expression differences were sta－tistically significant（F=67.778，P=0.000），and statistically significant differences in two different time points were ob－served（P=0.000，P=0.000，P=0.000）. Serum miRNA-21 expres－sion of 1 day after admission （1.974±0.886） ng/μL was higher than miRNA-21 expression of 3 day after admission（1.015±0.709） ng/μL；serum miRNA-21 expression of 3 day after admission （1.015±0.709） ng/μL was higher than miRNA-21 expression of 5 day after admission（0.531±0.312） ng/μL. ③In sepsis 5 d course，different time points of PCT expression differences were statistically significant（F=34.304，P=0.000），and statistically significant dif－ferences in two different time points were observed（P=0.000，P=0.000，P=0.000）. Serum PCT expression of 1 day after admission（14.164±13.939） μg/L was higher than PCT expression of 3 day after admission（4.224±4.039） μg/L；serum PCT expression of 3 day after admission（4.224±4.039） μg/L was higher than PCT expression of 5 day after admission（1.614±3.438） μg/L.④In septic shock group，the serum miRNA-21 expression of 1 day，PCT and APACHEⅡ were higher than those in general sepsis group（Z= -6.510，P=0.000；Z=-4.457，P=0.000；Z=-6.517，P=0.000）. The expression of miRNA-21 was positively correlated with APACHEⅡ score（r=0.993，P=0.000）. ⑤The expression of serum miRNA-21 in death group was higher than that in survival group，and there were significant differences between the two groups at each time point（Z=-2.823，P=0.005；Z=-3.664，P=0.000；Z=-4.942，P=0.000）. Conclusion：Serum miRNA-21 may be a potential marker for early diagnosis of sepsis，and has positive clinical signifi－cance in predicting the severity of sepsis and evaluating the prognosis. The dynamic expression of serum miRNA-21 in the course of sepsis may be closely related to the inflammatory response of the body.