| 朱先华.血清微小RNA-10a与IL-35水平评估脓毒症诱导急性肾损伤患者的预后价值[J].浙江中西医结合杂志,2019,29(6): |
| 血清微小RNA-10a与IL-35水平评估脓毒症诱导急性肾损伤患者的预后价值 |
| The evaluated values of serum levels of miRNA-10a and IL-35 to the prognosis in patients with sepsis induced acute kidney injury |
| 投稿时间：2018-11-19 修订日期：2019-05-29 |
| DOI： |
| 中文关键词: 【关键词】脓毒症 急性肾损伤 微小RNA-10a 白细胞介素-35 预后 |
| 英文关键词:sepsis, acute kidney injury, microRNA-10a, interleukin-35, prognosis, ROC curve |
| 基金项目: |
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| 摘要点击次数: 655 |
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| 中文摘要: |
| 【】目的：通过分析脓毒症诱导急性肾损伤(AKI)患者血清微小RNA-10a (miRNA-10a)与白细胞介素-35(IL-35)水平的动态变化,并评估两种指标检测对患者病情程度及短期预后结局的预测价值。方法：选择我院ICU治疗的90例脓毒症患者,按有无伴发AKI分为：观察组,共42例,脓毒症诱导AKI；对照组48例,脓毒症未诱导AKI发生。在治疗第1、7、14、28天分别测定并比较两组外周血清miRNA-10a、IL-35、降钙素原(PCT)、肌酐(Scr)、肾损伤分子1(KIM-1)、胱抑素C(Cys-C)、序贯器官衰竭评分(SOFA)指标。采用Pearson相关分析分别评估血清miRNA-10a、IL-35与PCT、Scr、KIM-1、Cys-C及SOFA评分间的相关性。随访3个月,根据预后结局分为：生存组与死亡组,比较两组血清miRNA-10a及IL-35水平。应用多元Logistic回归分析上述各临床指标与生存率的相关性。绘制受试者工作特征曲线(ROC)评估血清miRNA-10a联合IL-35水平对脓毒症诱导AKI患者短期预后的判断价值。结果：对照组治疗前后血清miRNA-10a、IL-35、PCT、Scr、KIM-1、Cys-C及SOFA评分差异无统计学意义(P均>0.05),观察组miRNA-10a、IL-35、PCT、Scr、KIM-1、Cys-C及SOFA评分随治疗时间而逐渐降低(P均<0.05),但同一时间点观察组各指标均大于对照组(P均<0.05)。Pearson相关分析显示脓毒症诱导AKI患者血清miRNA-10a与血清PCT、Scr、KIM-1、Cys-C及SOFA评分正相关(r分别为0.818、0.725、0.571,P均<0.05),血清IL-35与上述各指标呈正相关(r分别为0.865、0.858、0.564,P均<0.05)。多元Logistic回归分析显示,血清miRNA-10a与IL-35为脓毒症诱导AKI患者预后的危险性因素(OR=3.157, P=0.016、OR=2.426, P=0.027)。随访3月,生存组的血清miRNA-155与IL-35显著低于死亡组(P均<0.05)。ROC曲线显示,血清miRNA-10a截断值为3.15及IL-35截断值为355pg/mL,预测脓毒症患者预后不良发生的AUC为0.852(P=0.033),灵敏度为85.6%(95%CI: 0.810～0.924),特异度为87.9%(95%CI: 0.826～0.941)。结论 血清miRNA-10a及IL-35水平检测能较好地预测脓毒症诱导AKI患者的病情及短期预后。 |
| 英文摘要: |
| Objective To evaluate the clinical values of the dynamic variation of serum levels of microRNA (miRNA)-10a and interleukin (IL)-35 to the condition and prognosis in patients with sepsis induced acute kidney injury (AKI). Methods The 90 patients diagnosed to sepsis in ICU were collected and divided into two groups according to the diagnosis of the AKI, which were observation group (42 cases, confirmed to the sepsis induced AKI) and control group (48 cases, confirmed to the sepsis only). The serum levels of miRNA-10a, IL-35, procalcitonin (PCT), serum creatinine (Scr), kidney injury molecule-1 (KIM-1), cystatin C (Cys-C) and the scores of sequential organ failure assessment (SOFA) were detected and compared between two groups at 1st, 7th, 14th and 28th day post-therapy respectively. The correlations of serum levels of miRNA-10a and IL-35 to PCT, Scr, KIM-1, Cys-C and SOFA scores were confirmed by Pearson linear correlation analysis respectively. Follow-up three months, all the patients were divided into two groups according to the prognosis, which were survival group and death group. The serum levels of miRNA-10a and IL-35 were compared between two groups. The risk factors of survival rate to the serum levels of above indexes were confirmed by multivariate Logistic analysis. The diagnostic value of the serum levels of miRNA-10a and IL-35 to the prognosis of the patients with sepsis were analyzed by receiver operating characteristic curves (ROC). Results The serum levels of miRNA-10a, IL-35, PCT, Scr, KIM-1, Cys-C and SOFA scores in control group were no variety (all P>0.05). As the therapeutic time goes by, the serum levels of miRNA-10a, IL-35, PCT, Scr, KIM-1, Cys-C and SOFA scores in observation group were decreasing (all P<0.05), and the serum levels of miRNA-10a, IL-35, KIM-1 and Cys-C in observation group were higher than in control group at the same time-point (all P<0.05). The positive correlations of miRNA-10a to PCT, KIM-1, Cys-C and SOFA scores were confirmed by Pearson linear correlation analysis (r=0.818, 0.725, 0.571, all P<0.05), and there was also positive correlation of IL-35 to PCT, KIM-1, Cys-C and SOFA scores (r=0.865, 0.858, 0.564, all P<0.05). Multivariate Logistic analysis showed that the serum levels of miRNA-10a and IL-35 were independent risk factors to the survival rate of sepsis induced AKI (OR=3.157, P=0.016、OR=2.426, P=0.027). Follow-up three months, the serum levels of miRNA-155 and IL-35 in survival group were lower than in death group. When the cut-off point of serum miRNA-10a level was 3.15 and IL-35 level was 355 pg/mL, the AUC of predictions to the poor prognosis in sepsis induced AKI was 0.852 (P=0.033) and the sensitivity was 85.6%(95%CI: 0.810～0.924) and specificity was 87.9%(95%CI: 0.826～0.941). Conclusion The serum levels of miRNA-10a and IL-35 can perfect assess the condition and short-term prognosis of patients with sepsis. |
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