血清miR-133a在脓毒症并发ARDS中表达及预后的关系

doi:10.3877/cma.j.issn.1674-6902.2022.01.009

目的

分析血清微小核糖核酸(miR)-133a在脓毒症并发急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)患者中的表达及与预后的关系。

方法

选取2019年6月至2021年5月我院收治的65例脓毒症患者，根据是否并发ARDS，分为并发ARDS 35例和无ARDS 30例。随访28 d，统计脓毒症并发ARDS者预后，检测患者入住ICU第1天、第2天、第3天血清miR-133a水平，比较存活者和死亡者临床特征，采用Logistic回归分析判定影响脓毒症并发ARDS预后的因素，采用受试者工作曲线(ROC)分析血清miR-133a水平预测脓毒症并发ARDS者预后的价值。

结果

并发ARDS入住ICU第1天、第2天、第3天血清miR-133a水平均高于无ARDS者(P<0.05)；随访28 d，脓毒症并发ARDS者病死率为40.00%；死亡者入住ICU第1天、第2天、第3天血清miR-133a水平均高于存活者(P<0.05)；死亡者序贯器官衰竭(SOFA)评分、血管外肺水指数、第1天血清miR-133a水平与存活者比较，差异均有统计学意义(P<0.05)；Logistic多因素回归分析显示SOFA评分、第1天血清miR-133a水平均是影响脓毒症并发ARDS者死亡的危险因素(P<0.05)；ROC分析显示，第1天血清miR-133a水平预测脓毒症并发ARDS者死亡的最佳截断点为1.47，灵敏度为85.71%，特异度为90.48%，AUC为0.857。

结论

脓毒症并发ARDS者血清miR-133a水平升高，血清miR-133a水平是影响脓毒症并发ARDS者死亡的危险因素，监测血清miR-133a水平变化，作为预测患者预后的指标。

关键词: 急性呼吸窘迫综合征, 微小核糖核酸-133a, 脓毒症, 预后

Objective

To explore the expression of serum microribonucleic acid (miR)-133a in patients with sepsis and acute respiratory distress syndrome and its relationship with prognosis.

Methods

65 cases of sepsis admitted to the hospital from June 2019 to May 2021 were selected, according to whether they combined with acute respiratory distress syndrome, they were divided into concurrent group 35 and non-complicated group 30 cases. Follow-up for 28 days, the deaths of patients with sepsis combined with acute respiratory distress syndrome were counted, the serum level of miR-133a was detected on the first day, the second day, and the third day of the patient′s admission to the ICU, the clinical characteristics of the dead and surviving patients were compared, Logistic regression analysis was used to determine the factors affecting the death of patients with sepsis combined with acute respiratory distress syndrome, and receiver operating curve (ROC) was used to analyze the value of serum miR-133a level in predicting the death of patients with sepsis combined with acute respiratory distress syndrome.

Results

The serum miR-133a levels of patients with concurrent group ICU admission on day 1, 2, and 3 were higher than those of non-complicated group patients (P<0.05). After 28 days of follow-up, the mortality of patients with sepsis and acute respiratory distress syndrome was 40.00%. Serum miR-133a levels of dead patients were higher than those of surviving patients on day 1, 2, and 3 of ICU admission (P<0.05). The SOFA score, extravascular lung water index, miR-133a level on day 1 of dead patients were compared with those of surviving patients, and the differences were statistically significant (P<0.05). Logistic multivariate regression analysis showed that Sequential Organ Failure (SOFA) score and serum miR-133a level on day 1 were independent risk factors for death in patients with sepsis and acute respiratory distress syndrome (P<0.05). ROC analysis showed that the best cut-off point for serum miR-133a level on day 1 to predict the death of patients with sepsis and acute respiratory distress syndrome was1.47, the sensitivity was 85.71%, the specificity was 90.48%, and the area under the curve (AUC) was 0.857.

Conclusion

The level of serum miR-133a in patients with sepsis and acute respiratory distress syndrome is abnormally increased, and the level of serum miR-133a is an independent risk factor affecting death in patients with sepsis and acute respiratory distress syndrome, clinical monitoring of serum miR-133a level changes can be used as a sensitive indicator to predict patient death.

Key words: Acute respiratory distress syndrome, Microribonucleic acid-133a, Sepsis, Prognosis

表1 比较两组患者入住ICU不同时相血清miR-133a水平

组　别		例数	第1天	第2天	第3天
ARDS		35	1.35±0.23	1.14±0.16^a	0.95±0.12^b
无ARDS		30	1.16±0.18	0.95±0.14^a	0.68±0.10^b
	t值	-	3.663	5.053	9.755
	P值	-	0.001	0.000	0.000

表1 比较两组患者入住ICU不同时相血清miR-133a水平

组　别		例数	第1天	第2天	第3天
ARDS		35	1.35±0.23	1.14±0.16^a	0.95±0.12^b
无ARDS		30	1.16±0.18	0.95±0.14^a	0.68±0.10^b
	t值	-	3.663	5.053	9.755
	P值	-	0.001	0.000	0.000

表2 比较患者预后临床特征

临床资料		存活者(n＝21)	死亡者(n＝14)	t/χ²值	P值
基础疾病
	糖尿病	5(23.81)	3(21.43)	0.027	0.869
	高血压	7(33.33)	4(28.57)	0.088	0.766
	冠心病	3(14.29)	2(14.29)	0.243	0.622
APACHEⅡ评分(分)		11.58±1.94	12.27±2.31	0.955	0.346
SOFA评分(分)		5.17±0.83	7.86±1.14	8.087	0.001
机械通气时间(d)		6.88±1.10	7.25±1.32	0.900	0.375
ICU住院时间(d)		17.62±2.97	18.47±3.03	0.823	0.416
血管外肺水指数(ml/kg)		9.84±1.92	12.29±1.98	3.653	0.001
氧合指数(mmHg)		142.35±20.16	139.62±18.49	0.405	0.688
血乳酸(mmol/L)		5.08±0.79	5.26±0.84	0.644	0.524
C反应蛋白(mg/L)		17.95±2.86	18.43±3.10	0.470	0.641
白细胞(×10⁹/L)		15.78±2.37	16.53±2.62	0.880	0.385

表2 比较患者预后临床特征

临床资料		存活者(n＝21)	死亡者(n＝14)	t/χ²值	P值
基础疾病
	糖尿病	5(23.81)	3(21.43)	0.027	0.869
	高血压	7(33.33)	4(28.57)	0.088	0.766
	冠心病	3(14.29)	2(14.29)	0.243	0.622
APACHEⅡ评分(分)		11.58±1.94	12.27±2.31	0.955	0.346
SOFA评分(分)		5.17±0.83	7.86±1.14	8.087	0.001
机械通气时间(d)		6.88±1.10	7.25±1.32	0.900	0.375
ICU住院时间(d)		17.62±2.97	18.47±3.03	0.823	0.416
血管外肺水指数(ml/kg)		9.84±1.92	12.29±1.98	3.653	0.001
氧合指数(mmHg)		142.35±20.16	139.62±18.49	0.405	0.688
血乳酸(mmol/L)		5.08±0.79	5.26±0.84	0.644	0.524
C反应蛋白(mg/L)		17.95±2.86	18.43±3.10	0.470	0.641
白细胞(×10⁹/L)		15.78±2.37	16.53±2.62	0.880	0.385

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Expression of serum miR-133a in sepsis patients with acute respiratory distress syndrome and its relationship with prognosis

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Expression of serum miR-133a in sepsis patients with acute respiratory distress syndrome and its relationship with prognosis