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

1	凡　华，张国新，李　庚. MicroRNA-155联合MicroRNA-127对急性呼吸窘迫综合征预后的意义[J/CD]. 中华肺部疾病杂志(电子版), 2021, 14(6): 760-763.
2	郭亚威，王　征，曹　涛，等. SOFA评分联合降钙素原在脓毒症中的应用价值[J]. 中国急救复苏与灾害医学杂志，2020, 15(12): 1428-1431.
3	Font MD, Thyagarajan B, Khanna AK. Sepsis and septic shock-basics of diagnosis, pathophysiology and clinical decision making [J]. Med Clin North Am, 2020, 104(4): 573-585.
4	Stanski NL, Wong HR. Prognostic and predictive enrichment in sepsis[J]. Nat Rev Nephrol, 2020, 9(1): 20-31.
5	穆庆华，李　明. 急性创伤患者发生早期ARDS的危险因素分析[J]. 中国急救复苏与灾害医学杂志，2020, 15(3): 319-322.
6	Yehya N, Thomas NJ. Sepsis and pediatric acute respiratory distress syndrome [J]. J Pediatr Intensive Care, 2019, 8(1): 32-41.
7	Auriemma CL, Zhuo H, Delucchi K, et al. Acute respiratory distress syndrome-attributable mortality in critically ill patients with sepsis [J]. Intensive Care Med, 2020, 46(6): 1222-1231.
8	Englert JA, Bobba C, Baron RM. Integrating molecular pathogenesis and clinical translation in sepsis-induced acute respiratory distress syndrome[J]. JCI Insight, 2019, 4(2): 124-131.
9	Zhao J, Tan Y, Wang L, et al. Discriminatory ability and prognostic evaluation of presepsin for sepsis-related acute respiratory distress syndrome [J]. Sci Rep, 2020, 10(1): 9114-9120.
10	刘士琛，王美菊，刘　刚，等. 肺炎合并低氧血症患者进展为ARDS危险因素分析[J/CD]. 中华肺部疾病杂志(电子版), 2021, 14(2): 164-168.
11	Lee LK, Medzikovic L, Eghbali M, et al. The role of MicroRNAs in acute respiratory distress syndrome and sepsis, from targets to therapies: A narrative review [J]. Anesth Analg, 2020, 131(5): 1471-1484.
12	Tian X, Li L, Fu G, et al. miR-133a-3p regulates the proliferation and apoptosis of intestinal epithelial cells by modulating the expression of TAGLN2[J]. Exp Ther Med, 2021, 22(2): 824-830.
13	中国医师协会急诊医师分会，中国研究型医院学会休克与脓毒症专业委员会，于学忠，等. 中国脓毒症/脓毒性休克急诊治疗指南(2018)[J]. 临床急诊杂志，2018, 19(9): 567-588.
14	俞森洋. 对急性呼吸窘迫综合征诊断新标准(柏林定义)的解读和探讨[J]. 中国呼吸与危重监护杂志，2013, 12(1): 1-4.
15	Fowler AA 3rd, Truwit JD, Hite RD, et al. Effect of vitamin C infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure: The CITRIS-ALI randomized clinical trial [J]. JAMA, 2019, 322(13): 1261-1270.
16	Kerchberger VE, Bastarache JA, Shaver CM, et al. Haptoglobin-2 variant increases susceptibility to acute respiratory distress syndrome during sepsis[J]. JCI Insight, 2019, 4(21): 1312-1316.
17	Li S, Zhao D, Cui J, et al. Prevalence, potential risk factors and mortality rates of acute respiratory distress syndrome in Chinese patients with sepsis[J]. J Int Med Res, 2020, 48(2): 306-314.
18	Yadav B, Bansal A, Jayashree M. Clinical profile and predictors of outcome of pediatric acute respiratory distress syndrome in a PICU: A prospective observational study [J]. Pediatr Crit Care Med, 2019, 20(6): 263-273.
19	Munshi L, Walkey A, Goligher E, et al. Venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a systematic review and meta-analysis [J]. Lancet Respir Med, 2019, 7(2): 163-172.
20	Wei P, Xie Y, Abel PW, et al. Transforming growth factor (TGF)-β1-induced miR-133a inhibits myofibroblast differentiation and pulmonary fibrosis[J]. Cell Death Dis, 2019, 10(9): 670-677.
21	Qin LY, Wang MX, Zhang H. MiR-133a alleviates renal injury caused by sepsis by targeting BNIP3L[J]. Eur Rev Med Pharmacol Sci, 2020, 24(5): 2632-2639.
22	Martucci G, Arcadipane A, Tuzzolino F, et al. Identification of a circulating miRNA signature to stratify acute respiratory distress syndrome patients [J]. J Pers Med, 2020, 11(1): 15-22.
23	Chen L, He X, Xie Y, et al. Up-regulated miR-133a orchestrates epithelial-mesenchymal transition of airway epithelial cells [J]. Sci Rep, 2018, 8(1): 155-159.
24	Mendes FC, Paciência I, Ferreira AC, et al. Development and validation of exhaled breath condensate microRNAs to identify and endotype asthma in children [J]. PLoS One, 2019, 14(11): 983-988.
25	Yang M, Wang LI. MALAT1 knockdown protects from bronchial/tracheal smooth muscle cell injury via regulation of microRNA-133a/ryanodine receptor 2 axis [J]. J Biosci, 2021, 46(7): 28-36.
26	薛雨晨，薛晓梅，何　斌. 微小RNA-133a和微小RNA-499a-5p在脓毒性心肌病中的诊断和预后价值[J]. 国际麻醉学与复苏杂志，2019, 40(8): 759-764.
27	Shao Y, Chong L, Lin P, et al. MicroRNA-133a alleviates airway remodeling in asthtama through PI3K/AKT/mTOR signaling pathway by targeting IGF1R[J]. J Cell Physiol, 2019, 234(4): 4068-4080.
28	Chen L, Xie W, Wang L, et al. MiRNA-133a aggravates inflammatory responses in sepsis by targeting SIRT1 [J]. Int Immunopharmacol, 2020, 52(4): 229-236.

[1]	马中正, 杨云川, 马翔, 周迟, 丁丁, 霍俊一, 徐楠, 崔培元, 周磊. 胰腺癌双硫死亡相关的lncRNA预后模型的构建及免疫反应研究[J]. 中华普通外科学文献(电子版), 2024, 18(05): 368-376.
[2]	梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[3]	张志兆, 王睿, 郜苹苹, 王成方, 王成, 齐晓伟. DNMT3B与乳腺癌预后的关系及其生物学机制[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 624-629.
[4]	屈翔宇, 张懿刚, 李浩令, 邱天, 谈燚. USP24及其共表达肿瘤代谢基因在肝细胞癌中的诊断和预后预测作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 659-662.
[5]	顾雯, 凌守鑫, 唐海利, 甘雪梅. 两种不同手术入路在甲状腺乳头状癌患者开放性根治性术中的应用比较[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 687-690.
[6]	付成旺, 杨大刚, 王榕, 李福堂. 营养与炎症指标在可切除胰腺癌中的研究进展[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 704-708.
[7]	孙建娜, 孔令军, 任崇禧, 穆坤, 王晓蕊. 266例首诊Ⅳ期乳腺癌手术患者预后分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 502-505.
[8]	袁庆港, 刘理想, 张亮, 周世振, 高波, 丁超, 管文贤. 尿素-肌酐比值（UCR）可预测结直肠癌患者术后的长期预后[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 506-509.
[9]	黄福, 王黔, 金相任, 唐云川. VEGFR2、miR-27a-5p在胃癌组织中的表达与临床病理参数及预后的关系研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 558-561.
[10]	张瑜, 姜梦妮. 基于DWI信号值构建局部进展期胰腺癌放化疗生存获益预测模型[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 657-664.
[11]	伍细蓉, 徐立文, 陈亚琼. 基于LPR和FARI构建肝衰竭患者生存预后模型[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 675-681.
[12]	刘军, 丘文静, 孙方昊, 李松盈, 易述红, 傅斌生, 杨扬, 罗慧. 在体与离体劈离式肝移植在儿童肝移植中的应用比较[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 688-693.
[13]	唐诗, 薛传优, 叶兴, 张鸿举, 戴瑞. 急性病毒性肝炎患者血脂、血糖、蛋白、尿酸变化特点及其与预后的关联[J]. 中华消化病与影像杂志(电子版), 2024, 14(05): 396-399.
[14]	李素娟, 王文玲, 董洪敏, 李小凯, 黄思成, 王刚. 多原发与单原发大肠腺癌的预后分析[J]. 中华消化病与影像杂志(电子版), 2024, 14(05): 407-412.
[15]	郭曌蓉, 王歆光, 刘毅强, 何英剑, 王立泽, 杨飏, 汪星, 曹威, 谷重山, 范铁, 李金锋, 范照青. 不同亚型乳腺叶状肿瘤的临床病理特征及预后危险因素分析[J]. 中华临床医师杂志(电子版), 2024, 18(06): 524-532.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

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

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

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