血清miRNA-122a和降钙素原对脓毒症相关肝损伤早期诊断及预后评估的临床价值

doi:10.3969/j.issn.1006-5725.2019.16.021

摘要/Abstract

摘要： 目的探讨miRNA-122a、降钙素原（procalcitonin,PCT）对脓毒症相关肝损伤（sepsis related liver injury, SRLI）的早期诊断及预后评估的临床价值。方法选择152例脓毒症相关肝损伤的患者和同期46例脓毒症患者作为研究对象。脓毒症相关肝损伤组按肝损伤程度分为轻度、中度、重度肝损伤组。选择健康体检者40例作为对照组。分析两组患者的临床资料,采用RT-PCR测定血清miRNA-122a表达量。采用受试者工作特征ROC曲线分析miRNA-122a、PCT对脓毒症相关肝损伤的早期诊断价值。采用二元Logistic回归分析影响脓毒症相关肝损伤患者预后的危险因素。结果（1）与对照组比较,脓毒症组和肝损伤组患者的血清PCT浓度、miRNA-122a的表达量明显升高,差异有统计学意义（P < 0.01）。ROC曲线分析显示,血清miRNA-122a、PCT诊断脓毒症相关肝损伤的AUC分别为：0.788（95%CI：0.695 ~ 0.863）、0.756（95%CI：0.693 ~ 0.832）,当两者联合时AUC为0.868（95%CI：0.786 ~ 0.928）。（2）肝损伤三组患者血清miRNA-122a、PCT比较,差异有统计学意义,肝损伤组血清miRNA-122a、PCT显著高于无肝损组（P < 0.01）。（3）二元Logistic回归分析发现,肝损伤严重程度、APACHE II评分、SOFA评分、miRNA-122a是影响脓毒症相关肝损伤患者预后的独立危险因素。结论血清miRNA-122a联合PCT检测对评估脓毒症相关肝损伤具有较高的敏感度和特异度,且miRNA-122a对脓毒症相关肝损伤患者预后评估有一定的临床价值。

关键词: miRNA-122a, 降钙素原, 脓毒症相关肝损伤, 诊断, 预后

Abstract: Objective To investigate the clinical significance of miRNA-122a and procalcitonin （PCT） in early diagnosis and prognosis of sepsis related liver injury （SRLI）. Methods A total of 152 sepsis patients were selected as the research subjects. According to the occurrence of acute liver injury, they were divided into the liver injury group and the non-liver injury group. Sepsis related liver injury group was divided into mild liver injury group, moderate liver injury group and severe liver injury group according to the degree of liver injury. Forty healthy individuals were selected as controls. The expressions of miRNA-122a in serum were determined by reverse transcriptase polymerase chain reaction （RT-PCR）. Receiver operation characteristic curve （ROC） was used to evaluate the value of miRNA-122a and PCT for the diagnosis sepsis related liver injury. Binary logistic regression was used to analyze the prognostic risk factors of sepsis related liver injury patients. Results （1）Compared with the control group, PCT concentration and miRNA-122a expression level of patients in the sepsis group and sepsis-related liver injury group were significantly increased, with statistically significant differences （P < 0.01）. ROC curve analysis showed that the AUC of serum miRNA-122a and PCT for the diagnosis of sepsis related liver injury were： 0.788 （95%CI：0.695 ~ 0.863） and 0.756 （95%CI：0.693 ~ 0.832）. When miRNA-122a combined with PCT for the diagnosis of sepsis-related liver injury was 0.868 （95%CI：0.786 ~ 0.928）. （2）The expression levels of miRNA-122a and PCT in serum of liver injury groups were all higher than those in the no-liver injury group （P < 0.01）. 3. Binary logistic regression analysis found that the severity of liver injury, APACHE II score, SOFA score and miRNA-122a were independent risk factors affecting the prognosis of patients with sepsis related liver injury. Conclusion sSerum miRNA-122a combined with PCT test has high sensitivity and specificity in the evaluation of sepsis related liver injury, and miRNA-122a has certain clinical value in the evaluation of prognosis of patients with sepsis related liver injury.

Key words: miRNA-122a, procalcitonin, sepsis-related liver injury, diagnosis, prognosis

桑珍珍, 高杰, 贾春梅, 李勇. 血清miRNA-122a和降钙素原对脓毒症相关肝损伤早期诊断及预后评估的临床价值[J]. 实用医学杂志, 2019, 35(16): 2611-2614.

SANG Zhenzhen, GAOJie, JIA Chunmei, LI Yong. Clinical value of serum miRNA-122a and PCT in the early diagnosis and prognosis of sepsis-related liver injury[J]. The Journal of Practical Medicine, 2019, 35(16): 2611-2614.

参考文献 13

[1]	SINGER M, DEUTSCHMAN C S, SEYMOUR C W, et al.The third international consensus. definitions for sepsis and septic shock (Sepsis-3)[J]. JAMA, 2016, 315(8):801-810.
[2]	姜丽静,倪金迪,孙英杰,等.脓毒症患者发生急性肝功能障碍诱因的多因素回归分析[J].肝脏, 2016, 21(4):286-289.
[3]	RAHMEL T, SCHAFER S T, FREY U H, et al.Increased circulating microRNA-122 is a biomarker for discrimination and risk stratification in patients defined by sepsis-3 criteria[J]. PLoS One, 2018,13(5):e0197637.
[4]	赵蓉, 董士民. 血清endocan和降钙素原对脓毒症早期诊断及预后评估的临床价值[J]. 中华危重病急救医学, 2017, 29(4):321-326.
[5]	BONE R C, BALK R A, CERRA F B, et al.Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine[J]. Chest, 1992, 101(6): 1644-1655.
[6]	马兴龙, 姜阳, 李佳芯, 等. 脓毒症患者外周血TNF-α、HMGB-1、TF和vWF动态变化及临床意义[J]. 实用医学杂志, 2018,34(4):630-633.
[7]	匡雨琼, 刘亮, 许飞飞,等. microRNA-122作为新药肝毒性早期评价标志物的相关分析[J]. 南京医科大学学报(自然科学版),2018,3:322-327.
[8]	JIA Y X, PAN C S, YANG J H, et al.Altered L-arginine/nitric oxide synthase/nitric oxide pathway in the vascular adventitia of rats with sepsis[J]. Clin Exp Pharmacol Physiol, 2006, 33(12):1202-1208.
[9]	MALLET M, TRIPON S, THABUT D, et al.Elevated levels of procalcitonin during acute liver failure are not associated with sepsis or worth outcome[J]. J Hepatol,2016, 64(2): S308-S309.
[10]	WHANG K T, VATH S D, BECKER K L, et al.Procalcitonin and proinflammatory cytokine in interactions in sepsis[J]. Shock, 1999,12(4): 268-273.
[11]	WOZNICA E, LYSENKO L.Procalcitonin in liver dysfunction-Dr Jekyll or Mr Hyde?[J]. Anaesthesiol Intensive Ther, 2018,50(3):226-229.
[12]	RAHMEL T, RUMP K, ADAMZIK M, et al.Increased circulating microRNA-122 is associated with mortality and acute liver injury in the acute respiratory distress syndrome[J]. BMC Anesthesiol, 2018,18(1):75.
[13]	LI X, CAO Y, LIU Z, et al.The relationship between liver injury and serum levels of C-reactive protein and procalcitoninin patients with acute pancreatitis[J]. J Coll Physicians Surg Pak,2019,29(3):287-289.

[1]	马于琪, 梁明明, 尹华发. 新型布尼亚病毒感染的临床特征及预后影响因素分析[J]. 实用医学杂志, 2020, 36(23): 3231-3236.
[2]	刘静一, 杨世海, 孙旭, 康婷, 陈文军, 吕博, 蒋盼, 梁显泉, 梅傲冰. 脓毒症患者降钙素原和C⁃反应蛋白与序贯器官衰竭估计评分的相关性及其影响因素分析[J]. 实用医学杂志, 2020, 36(23): 3241-3245.
[3]	刘新峰, 韩燕, 蒲伟, 刘昌杰, 王荣品, 田野, 翟茂雄. T1 mapping技术定量分析肥厚型心肌病纤维化[J]. 实用医学杂志, 2020, 36(23): 3269-3278.
[4]	陈庆康, 陈蔚蔚, 邓素雅, 廖涛, 陈中恒. 彩色多普勒超声与MRI结合心肌损伤标志物对心肌梗死左心室室壁瘤诊断的对比研究[J]. 实用医学杂志, 2020, 36(23): 3279-3282.
[5]	杨韵贤, 李世梅, 姚继祎, 郝少云, 智慧. 美国癌症联合委员会第八版乳腺癌预后分期Ⅰ-Ⅲ期与肿物BI⁃RADS分类超声特征的关系[J]. 实用医学杂志, 2020, 36(22): 3140-3143.
[6]	高珣, 王玉凤, 肖青勉, 朱倩倩, 王璞, 王维展. 无创血流动力学监测在急性百草枯中毒病情评估中的作用[J]. 实用医学杂志, 2020, 36(21): 2947-2952.
[7]	黄杏玲, 邓新娥, 王远流, 陈惠, 刘百灵. 不同类型胎儿先天性心脏病的产前诊断及预后分析[J]. 实用医学杂志, 2020, 36(21): 2990-2994.
[8]	方亮, 熊晓云, 方路, 黄跃英, 杜晓红, 王恺, 朱燕珍, 李欣. 基于ESPEN标准探讨四种营养筛查工具对肝细胞肝癌患者的营养评估及预后价值[J]. 实用医学杂志, 2020, 36(20): 2792-2801.
[9]	周旭东, 赵兴华, 许长宝, 郝斌, 李武学, 赵永立. 循环肿瘤细胞在前列腺癌诊断中的价值[J]. 实用医学杂志, 2020, 36(20): 2843-2847.
[10]	王静, 王思思, 马会, 王萍, 武欣, 刘晓娟, 马春星. 长链非编码linc00511在卵巢癌中的表达、临床意义及预后分析[J]. 实用医学杂志, 2019, 35(16): 2584-2586.
[11]	胡文兵, 陶泽璋, 费新雄, 顾磊, 朱苏谨, 陈军. 鼻咽癌组织中S100A8和S100A9的表达与预后的相关性[J]. 实用医学杂志, 2019, 35(16): 2587-2591.
[12]	李仕雄, 许超宇, 吕日英, 陈茂伟. 马尔尼菲蓝状菌病预后模型的构建[J]. 实用医学杂志, 2019, 35(16): 2603-2606.
[13]	肖成业, 杨国帅, 余丹, 程启慧, 孙荣道. 美金刚对抑郁发作的非痴呆性血管性认知功能障碍患者的影响[J]. 实用医学杂志, 2019, 35(16): 2628-2632.
[14]	刘娜, 张长庚, 李伟, 孙巨勇. 趋化因子γ干扰素诱导蛋白-10和巨噬细胞炎性蛋白-3a在肝癌患者外周血中的表达及诊断价值[J]. 实用医学杂志, 2019, 35(16): 2641-2644.