目的

分析血清miR-146a 在脓毒症并发急性肺损伤（acute lung injury，ALI）患者中的表达水平及与预后的相关性。

方法

选取2021 年1 月至2024 年12 月我院收治的69 例脓毒症合并发ALI 患者为对象。 根据患者的生存情况，将生存者45 例为对照组，死亡者24 例为观察组。 比较两组患者的临床资料，进行单因素及多因素Logistic 回归分析。 分析miR-146a 表达水平与急性生理与慢性健康评价（acute physiology and chronic health e-valuationⅡ，APACHE Ⅱ）评分的相关性，绘制受试者工作特征曲线（receiver operating characteristic curve，ROC），判断血清miR-146a 诊断脓毒症并发ALI 患者预后的意义。

结果

观察组APACHE Ⅱ评分（28.74±11.59）分、SOFA 评分（14.06±4.67）分、LIS 评分（2.45±0.51）分、CRP 水平（37.24±6.35）μg/ml、miR-146a 表达水平（2.68±1.39）高于对照组（19.38±9.46）分、（9.25±3.40）分、（2.09±0.35）分、（26.67±4.51）ug/ml、（1.44±0.81）；观察组脓毒症休克24 例（77.42%）高于对照组11 例（20.00%）（P＜0.05）。 Spearman 相关性分析显示，miR-146a 表达水平与APACHEⅡ评分正相关（r=0.259、P=0.016）。 多因素Logislic 回归分析显示，发生脓毒症休克、APACHE Ⅱ评分、器官功能衰竭评分（sequential organ failure assessment，SOFA）、肺损伤评分（lung injury score，LIS）、CRP 水平和miR-146a表达水平是脓毒症并发ALI 患者预后不良的危险因素（P＜0.05）。 血清miR-146a 预测脓毒症并发ALI患者预后不良的AUC 值为0.789（95%CI：0.681～0.897），灵敏度为61.3%，特异度为89.1%。

结论

血清miR-146a 在脓毒症并发ALI 中的表达与预后相关，可作为判断病情严重程度和预测预后的潜在生物标志物。

Objective

To investigate the expression level of serum miR-146a in patients with sepsis complicated with acute lung injury （ALI） and its correlation with prognosis.

Methods

Sixty-nine patients with sepsis complicated with ALI admitted to Tongchuan People′s Hospital from January 2021 to December 2024 were selected. According to the survival status of the patients，they were divided into the control group 45 cases and the observation group 24 cases. The clinical data of the two groups of patients were compared，and univariate analysis was conducted. The factors with statistical significance were subjected to multivariate Logistic regression analysis. The correlation between the expression level of miR-146a and the Acute Physiology and Chronic Health Evaluation Ⅱ（APACHE Ⅱ） score was analyzed，and a receiver operating characteristic curve（ROC） was constructed to predict the performance of serum miR-146a in diagnosing the prognosis of patients with sepsis complicated with ALI.

Results

The observation group exhibited significantly higher APACHE Ⅱscores （28.74±11.59 vs. 19.38±9.46，P ＜0.05），Sequential Organ Failure Assessment （SOFA） scores（14.06±4.67 vs. 9.25±3.40，P＜0.05），Lung Injury Scores （LIS） （2.45±0.51 vs. 2.09±0.35，P＜0.05），C-reactive protein （CRP） levels （37.24±6.35 μg/ml vs. 26.67±4.51 μg/ml，P ＜0.05），and miR-146a expression levels （2.68±1.39 vs. 1.44±0.81，P＜0.05） compared to the control group. The incidence of septic shock was significantly higher in the observation group 24 cases （77.42%） than in the control group 11 cases（20.00%） ，P ＜0.05. Spearman correlation analysis revealed a positive association between miR-146a expression and APACHE Ⅱscores （r=0.259，P=0.016）. Multivariate logistic regression identified septic shock，higher APACHE Ⅱscores，SOFA scores，LIS scores，CRP levels，and elevated miR-146a expression as independent risk factors for poor prognosis （P＜0.05）. The area under the ROC curve （AUC） for serum miR-146a in predicting poor prognosis was 0.789 （95%CI： 0.681 ～0.897），with a sensitivity of 61.3% and specificity of 89.1%，indicating strong predictive value.

Conclusion

The expression of serum miR-146a in sepsis complicated with ALI is closely related to the prognosis of patients，and it can be used as a potential biomarker for judging the severity of the disease and predicting the prognosis.