外周血游离线粒体DNA、miR-146a表达对评估脓毒症患者近期预后的价值

doi:10.3969/j.issn.1006-5725.2024.23.012

Abstract

Abstract:

Objective To explore the value of free mitochondrial deoxyribonucleic acid （DNA） and micro ribonucleic acid （miRNA， miR）?146a expression in peripheral blood in assessing short?term prognosis of sepsis. Methods Totally 145 patients with sepsis admitted to the hospital from March 2021 to February 2023 were selected to detect the free mitochondrial DNA and miR?146a expression in peripheral blood. The incidence of poor prognosis after 28 days was counted， and the patients were then divided into poor prognosis group and good prognosis group. The general data and the free mitochondrial DNA and miR?146a expression in peripheral blood of the two groups were compared. Logistic regression analysis was used to explore the influencing factors of poor prognosis in patients. Receiver operating characteristic （ROC） curve was drawn to analyze the predictive efficacy of free mitochondrial DNA and miR?146a expressionin assessing the short?term prognosis of sepsis. Results The incidence of poor short?term prognosis in the 139 patients who completed the study was 28.78%. Concurrent diabetes （OR = 1.765， 95%CI：1.181 ~ 2.637）， acutephysiology and chronic health evaluation （APACHE Ⅱ） score （OR = 1.972， 95%CI：1.317 ~ 2.953）， free mitochondrial DNA in peripheral blood （OR = 2.416， 95%CI：1.524 ~ 3.829）， and miR?146a expression （OR = 2.462， 95%CI：1.431 ~ 4.237） were risk factors for poor short?term prognosis of patients with sepsis （P < 0.05）. The sensitivity， specificity and area under curve （AUC） of free mitochondrial DNA and miR?146a expression in peripheral blood to predict poor short?term prognosis were higher than those of APACHE Ⅱ score （P < 0.05）， and the sensitivity and AUC of free mitochondrial DNA and miR?146a expressions in peripheral blood to predict poor short?term prognosis were higher than those of both alone （P < 0.05）. Conclusions Free mitochondrial DNA and miR?146a expression in peripheral blood are related to poor short?term prognosis of sepsis. The efficacy of both of them in assessing poor short?term prognosis of sepsis is better than that of APACHE Ⅱ score， and their combined prediction efficacy is even better.

Key words: mitochondria, deoxyribonucleic acid, micro ribonucleic acid -146a, sepsis, prognosis

CLC Number:

R631⁺.2

Haiyan WU,Baoyu WANG,Baohui JIA. Predictive efficacy of free mitochondrial DNA and miR⁃146a expression in peripheral blood in assessing short term prognosis of sepsis[J]. The Journal of Practical Medicine, 2024, 40(23): 3356-3361.

Figures/Tables 6

Tab.1

Comparison of general information between the poor prognosis group and the good prognosis group"

一般资料	预后不良组（n = 40）	预后良好组（n = 99）	$χ 2$ /t值	P值
性别/［例（%）］			0.562	0.453
男	25（62.50）	55（55.56）
女	15（37.50）	44（44.44）
年龄（x ± s）/岁	54.85 ± 9.25	41.30 ± 7.04	9.352	< 0.001
原发病/［例（%）］			0.173	0.677
肺部感染	13（32.50）	32（32.32）
泌尿系统感染	8（20.00）	22（22.22）
手术切口感染	10（25.00）	24（24.24）
腹腔感染	7（17.50）	16（16.16）
其他	2（5.00）	5（5.05）
致病微生物/［例（%）］			0.075	0.784
细菌	25（62.50）	66（66.67）
真菌	6（15.00）	11（11.11）
病毒	6（15.00）	15（15.15）
其他	3（7.50）	7（7.07）
合并高血压/［例（%）］	9（22.50）	16（16.16）	0.776	0.378
合并糖尿病/［例（%）］	16（40.00）	17（17.17）	8.200	0.004
合并高脂血症/［例（%）］	10（25.00）	18（18.18）	0.823	0.364
脓毒性休克/［例（%）］	19（47.50）	4（4.04）	38.967	< 0.001
APACHE Ⅱ评分（x ± s）/分	30.13 ± 13.67	22.42 ± 7.46	4.262	< 0.001
PCT（x ± s）/（ng/mL）	8.35 ± 1.69	4.52 ± 0.71	18.870	< 0.001
CRP（x ± s）/（mg/L）	152.73 ± 30.05	69.55 ± 11.08	23.907	< 0.001
血乳酸（x ± s）/（μmol/L）	8.76 ± 1.24	4.83 ± 0.82	21.885	< 0.001
白细胞计数（x ± s）/（×10⁹个/L）	20.58 ± 4.15	19.63 ± 3.88	1.281	0.202
血红蛋白（x ± s）/（g/L）	112.37 ± 22.59	120.08 ± 24.46	1.719	0.088
纤维蛋白原（x ± s）/（g/L）	3.24 ± 0.69	3.05 ± 0.62	1.583	0.116

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

Fig.1

References 23

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变量	赋值
合并糖尿病	否=0，是=1
APACHE Ⅱ评分	实测值
外周血游离线粒体DNA	实测值
miR-146a表达	实测值
近期预后不良	否=0，是=1

影响因素	β	SE	Wald χ²	P值	OR（95%CI）
合并糖尿病	0.568	0.205	7.677	< 0.001	1.765（1.181 ~ 2.637）
APACHE Ⅱ评分	0.679	0.206	10.864	< 0.001	1.972（1.317 ~ 2.953）
外周血游离线粒体DNA	0.882	0.235	14.086	< 0.001	2.416（1.524 ~ 3.829）
miR-146a表达	0.901	0.277	10.580	< 0.001	2.462（1.431 ~ 4.237）

指标	Cut-off值	灵敏度/%	特异度/%	AUC（95%CI）
外周血游离线粒体DNA（pg/mL）	3 315.2	80.00（32/40）^?	92.93（92/99）^?	0.884（0.819 ~ 0.932）^?
miR-146a表达	2.3	82.50（33/40）^?	90.91（90/99）^?	0.926（0.869 ~ 0.963）^?
APACHE Ⅱ评分（分）	27	65.00（26/40）	81.82（81/99）	0.653（0.567 ~ 0.731）
外周血游离线粒体DNA联合miR-146a表达	-	100.00（40/40）^#	89.90（89/99）	0.979（0.938 ~ 0.996）^#

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Predictive efficacy of free mitochondrial DNA and miR⁃146a expression in peripheral blood in assessing short term prognosis of sepsis

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组别	例数	外周血游离线粒体DNA/（pg/mL）	miR-146a表达
预后不良组	40	3 552.35 ± 416.04	2.73 ± 0.47
预后良好组	99	2 882.06 ± 437.30	1.92 ± 0.31
t值		8.294	11.927
P值		< 0.001	< 0.001